Active NPI
Kirby O'Brien, MA, NCC, LPC
- Professional Counselor
- Washington, IL
National Provider Identifier
1457996324
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 178.015405
- Practice address
- 1003 N Cummings LN
Washington, IL 61571-9646 - Phone
- (309) 444-1000
- NPI assigned
- Nov 14, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 178.015405 | IL | Primary |
Addresses
Primary practice location
1003 N Cummings LN
Washington, IL 61571-9646
Mailing address
722 Mallard Way
Washington, IL 61571-9285
Phone (309) 265-6614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.015405 | IL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1573689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573689600000",
"number": "1457996324",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "722 MALLARD WAY",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719285",
"telephone_number": "309-265-6614"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1003 N CUMMINGS LN",
"city": "WASHINGTON",
"state": "IL",
"postal_code": "615719646",
"telephone_number": "309-444-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'BRIEN",
"first_name": "KIRBY",
"credential": "MA, NCC, LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-11-14",
"last_updated": "2019-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "178.015405",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Washington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.