Basic Information
| Provider Information | |||||||||
| NPI: | 1952636193 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'LEARY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | IMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 N 6TH ST | ||||||||
| Address2: | APT. 203 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432013690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149357748 | ||||||||
| FaxNumber: | 6142528468 | ||||||||
| Practice Location | |||||||||
| Address1: | 5131 POST RD | ||||||||
| Address2: | STE. 375 | ||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430171160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6149357748 | ||||||||
| FaxNumber: | 6142528468 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2009 | ||||||||
| LastUpdateDate: | 04/30/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | F 1000002 | OH | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.