MEDICARE: LIANN OSBORNE MFT-INTERN

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	101YM0800X	Mental Health Counselor	51018	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01AZ	OTHER	CA	MEDICAL

General Provider Information

NPI Number	:	1841480514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANN OSBORNE MFT-INTERN

Provider Business Mailing Address
First Line	:	25580 CAMPUS DR
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94542-1137
Country	:	US
Telephone Number	:	510-881-2245
Fax Number	:	510-881-2248

Provider Business Practice Location Address
First Line	:	25580 CAMPUS DR
Second Line	:
City	:	HAYWARD
State	:	CA
Zip	:	94542-1137
Country	:	US
Telephone Number	:	510-881-2245
Fax Number	:	510-881-2248

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	07/30/2007

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