Basic Information
Provider Information | |||||||||
NPI: | 1770728180 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | O'RILEY | ||||||||
FirstName: | CHRISTINE | ||||||||
MiddleName: | ANN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PSY.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | CMR 402 BOX 877 | ||||||||
Address2: |   | ||||||||
City: | APO | ||||||||
State: | AE | ||||||||
PostalCode: | 091800877 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3144865451 | ||||||||
FaxNumber: | 3144867366 | ||||||||
Practice Location | |||||||||
Address1: | 1900 8TH AVE SE | ||||||||
Address2: |   | ||||||||
City: | MINOT | ||||||||
State: | ND | ||||||||
PostalCode: | 587014935 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7018575998 | ||||||||
FaxNumber: | 7018575022 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/15/2008 | ||||||||
LastUpdateDate: | 03/02/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/02/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | NC 3363 | NC | N |   | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 611 | ND | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.