Kaitlyn O'Brien, LPC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

178017085 Issued in IL

Practice address

2704 N Main St
Rockford, IL 61103-3112

Phone

(815) 720-5063

NPI assigned

Jul 6, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kaity O'Brien Other name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Willow Creek Counseling LLC

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1144941394
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1912578469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 N MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2704 N MAIN ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611033112",
            "telephone_number": "815-720-5063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "KAITLYN",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "178017085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITY",
            "last_name": "O'BRIEN",
            "credential": "LPC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Chijindu Nnaemeka Nwakama, MD
• Catherine Nwosu
• Rebecca J Nygren, P.T., D.P.T.
• Scott R Nyquist, MD
• John Andrew O'Brien, DDS
• Heather Marie O'Connor
• Kathleen Marie O'Dierno, LCSW
• Carol J O'Haron, LCSW
• Mary B O'Meara, FNP
• Nicole Ann O'Neill, RDN

• Mental Health Counselor in Rockford, IL
• Providers in Rockford, IL by specialty
• Mental Health Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.