Provider Demographics
NPI:1053156273
Name:O'BRIEN, NICOLE TARA (LPC, MS)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:TARA
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600A E SELTICE WAY # 411
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7941
Mailing Address - Country:US
Mailing Address - Phone:208-582-3665
Mailing Address - Fax:
Practice Address - Street 1:1500 NORTHWEST BLVD STE 204
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2413
Practice Address - Country:US
Practice Address - Phone:208-582-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1261477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional