Healthcare Provider Details

I. General information

NPI: 1841370889
Provider Name (Legal Business Name): TAMI LYNN OSBURN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMI LYNN RISAVI LCSW

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1123 VERMONT AVE
ALAMOGORDO NM
88310-6340
US

IV. Provider business mailing address

PO BOX 1512
ALAMOGORDO NM
88311-1512
US

V. Phone/Fax

Practice location:
  • Phone: 575-415-9270
  • Fax: 208-978-7050
Mailing address:
  • Phone: 402-350-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06310
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-06310
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: