Healthcare Provider Details

I. General information

NPI: 1598492019
Provider Name (Legal Business Name): MS. COURTNEY SUSANE OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 11/05/2023
Certification Date: 11/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COTTONWOOD ST
WOODLAND CA
95695-3603
US

IV. Provider business mailing address

738 MULBERRY LN
DAVIS CA
95616-3417
US

V. Phone/Fax

Practice location:
  • Phone: 916-344-0199
  • Fax:
Mailing address:
  • Phone: 510-919-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: