Healthcare Provider Details

I. General information

NPI: 1174744809
Provider Name (Legal Business Name): CHRISTINE C OSMUNDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE CARTER

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5983 KINGSFORD AVE
PARK CITY UT
84098-6315
US

IV. Provider business mailing address

PO BOX 3075
PARK CITY UT
84060-3075
US

V. Phone/Fax

Practice location:
  • Phone: 303-917-4207
  • Fax:
Mailing address:
  • Phone: 303-917-4207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12795149-6004
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4525
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0153561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: