Doctor Name: | MICHELE JOANN OSMOND |
NPI Number: | 1053773952 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC |
License Number: | LCPC-3303 |
Business Practice Address: | 421 Memorial Dr Pocatello, ID - 832014008 |
Business Phone Number: | 2082347917 |
Business Fax Number: | 2082366328 |
Mailing Address: | 421 Memorial Dr, POCATELLO |
State: | ID |
Postal Code: | 832014008 |
Phone Number: | 2082347917 |
Fax Number: | 2082366328 |
NPI Enumeration Date: | 03/22/2016 |
NPI Last Update Date: | 03/22/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | LCPC-3303 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |