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General NPI Number Information
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NPI Number | 1407232788
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Entity Type | Individual
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Provider Name | AMY ELIZABETH OMSBERG BCBA, LBA
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Gender | Female
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Dates
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Enumeration Date | 08/10/2015
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 2700 EARL RUDDER FWY S SUITE1200
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City | COLLEGE STATION
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State | TX
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Zip | 77845-5010
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Country | US
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Telephone | 979-307-5850
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Fax | 855-380-4004
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Provider Business Mailing Address
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Address Line | 305 NE LOOP 820 BUSINESS TOWER 1, SUITE 200
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City | HURST
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State | TX
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Zip | 76053-7209
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Country | US
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Telephone | 817-282-8787
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Fax | 817-789-6849
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-41584
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License Number State | TX
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