MEDICARE: JAYCIE KAYLE OSBORNE

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	101YP2500X	Professional Counselor	87968	TX

General Provider Information

NPI Number	:	1720731896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYCIE KAYLE OSBORNE

Provider Business Mailing Address
First Line	:	2681 MACARTHUR BLVD STE 302
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8260
Country	:	US
Telephone Number	:	469-389-1123
Fax Number	:

Provider Business Practice Location Address
First Line	:	2681 MACARTHUR BLVD STE 302
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-8260
Country	:	US
Telephone Number	:	469-389-1123
Fax Number	:

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

Provider Enumeration Date	:	01/30/2022
Last Update Date	:	07/24/2023

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Directions to “ JAYCIE KAYLE OSBORNE ” Practice Location

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