MEDICARE: DR. CAROL L. O'SABEN LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2868	NC
2	103TC0700X	Clinical Psychologist	4292	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174592380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL L. O'SABEN LP

Provider Business Mailing Address
First Line	:	4289 CANYON LOOP
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-3726
Country	:	US
Telephone Number	:	828-773-7522
Fax Number	:

Provider Business Practice Location Address
First Line	:	4289 CANYON LOOP
Second Line	:
City	:	FLAGSTAFF
State	:	AZ
Zip	:	86005-3726
Country	:	US
Telephone Number	:	828-773-7522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	11/26/2017

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