Healthcare Provider Details

I. General information

NPI: 1407232788
Provider Name (Legal Business Name): AMY ELIZABETH OMSBERG BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 10/15/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 EARL RUDDER FWY S SUITE1200
COLLEGE STATION TX
77845-5010
US

IV. Provider business mailing address

305 NE LOOP 820 BUSINESS TOWER 1, SUITE 200
HURST TX
76053-7209
US

V. Phone/Fax

Practice location:
  • Phone: 979-307-5850
  • Fax: 855-380-4004
Mailing address:
  • Phone: 817-282-8787
  • Fax: 817-789-6849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: