1568903292 NPI number — STEPHANIE LYNN WALTS-OSMA M.A., L.P.C.

NPI Number: 1568903292
Health Care Provider/Practitioner: STEPHANIE LYNN WALTS-OSMA M.A., L.P.C.

NPI Number : 1568903292 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568903292",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALTS-OSMA",
    "FirstName": "STEPHANIE",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.A., L.P.C.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "OSMA",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "LYNN",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "M.A., L.P.C.",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "5721 TAYLORCREST DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AUSTIN",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "78749-4284",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "512-663-4724",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2525 WALLINGWOOD DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUSTIN",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "78746-6900",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "512-710-9840",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/14/2017",
    "LastUpdateDate": "03/28/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "72225",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "72225",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}