MEDICARE: NATHALIA OSBY

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	74901	TX

General Provider Information

NPI Number	:	1750936464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHALIA OSBY

Provider Business Mailing Address
First Line	:	2115 BOYCE ST APT A
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71301-3708
Country	:	US
Telephone Number	:	504-505-0632
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MAIN ST STE 600
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3011
Country	:	US
Telephone Number	:	817-657-2564
Fax Number	:

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

Provider Enumeration Date	:	08/08/2019
Last Update Date	:	08/08/2019

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