Healthcare Provider Details

I. General information

NPI: 1598146359
Provider Name (Legal Business Name): BIANCA OSUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 ANNUNCIATION ST
NEW ORLEANS LA
70115-1318
US

IV. Provider business mailing address

3805 ANNUNCIATION ST
NEW ORLEANS LA
70115-1318
US

V. Phone/Fax

Practice location:
  • Phone: 504-408-8490
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: