Provider Demographics
NPI:1174592380
Name:O'SABEN, CAROL L (LP)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:L
Last Name:O'SABEN
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4289 CANYON LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86005-3726
Mailing Address - Country:US
Mailing Address - Phone:828-773-7522
Mailing Address - Fax:
Practice Address - Street 1:4289 CANYON LOOP
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86005-3726
Practice Address - Country:US
Practice Address - Phone:828-773-7522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2017-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2868103TC0700X
AZ4292103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000806Medicaid
NC6000806Medicaid