MEDICARE: CHRISTINE C OSMUNDSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4525	CO
2	101YP2500X	Professional Counselor	0153561	NM
3	101YM0800X	Mental Health Counselor	12795149-6004	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174744809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE C OSMUNDSON

Provider Business Mailing Address
First Line	:	PO BOX 3075
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84060-3075
Country	:	US
Telephone Number	:	303-917-4207
Fax Number	:

Provider Business Practice Location Address
First Line	:	5983 KINGSFORD AVE
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-6315
Country	:	US
Telephone Number	:	303-917-4207
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	01/03/2024

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Directions to “ CHRISTINE C OSMUNDSON ” Practice Location

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