Healthcare Provider Details

I. General information

NPI: 1316673148
Provider Name (Legal Business Name): DIANA C OCHOA - OSORIO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5325 26TH ST W
BRADENTON FL
34207-3012
US

IV. Provider business mailing address

101 RIVERFRONT BLVD STE 710
BRADENTON FL
34205-8812
US

V. Phone/Fax

Practice location:
  • Phone: 941-752-7173
  • Fax: 941-567-6277
Mailing address:
  • Phone: 941-776-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21035
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: