Provider Demographics
NPI:1437264157
Name:OSSEFORT, CANDYCE S (LPC)
Entity type:Individual
Prefix:
First Name:CANDYCE
Middle Name:S
Last Name:OSSEFORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CANDYCE
Other - Middle Name:
Other - Last Name:OSSEFORT-RUSSELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1615 W 6TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5077
Mailing Address - Country:US
Mailing Address - Phone:512-789-6244
Mailing Address - Fax:512-474-1237
Practice Address - Street 1:1615 W 6TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5077
Practice Address - Country:US
Practice Address - Phone:512-789-6244
Practice Address - Fax:512-474-1237
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18127101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional