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General NPI Number Information
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NPI Number | 1598492019
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Entity Type | Individual
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Provider Name | MS. COURTNEY SUSANE OSBORNE
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Gender | Female
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Dates
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Enumeration Date | 08/04/2022
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Last Update Date | 11/05/2023
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Provider Practice Location Address
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Address Line | 520 COTTONWOOD ST
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City | WOODLAND
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State | CA
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Zip | 95695-3603
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Country | US
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Telephone | 916-344-0199
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Fax |
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Provider Business Mailing Address
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Address Line | 738 MULBERRY LN
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City | DAVIS
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State | CA
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Zip | 95616-3417
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Country | US
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Telephone | 510-919-9952
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Fax |
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Authorized Official
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Title or Position |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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