1851443006 NPI number — MS. CANDACE WILLIAMS OSBORN MFT

Table of content: MS. CANDACE WILLIAMS OSBORN MFT (NPI 1851443006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851443006 NPI number — MS. CANDACE WILLIAMS OSBORN MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSBORN
Provider First Name:
CANDACE
Provider Middle Name:
WILLIAMS
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851443006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 GREENWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94301-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-323-9629
Provider Business Mailing Address Fax Number:
650-323-2585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
261 HAMILTON AVE
Provider Second Line Business Practice Location Address:
SUITE #419
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94301-2533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-322-1245
Provider Business Practice Location Address Fax Number:
650-322-1262
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 44605 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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