Provider Demographics
NPI:1437646429
Name:OSMONSON, PATRICK JOSEPH (LISAC, CCTP)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:OSMONSON
Suffix:
Gender:M
Credentials:LISAC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 GLORIA AVE
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-8107
Mailing Address - Country:US
Mailing Address - Phone:928-419-1627
Mailing Address - Fax:
Practice Address - Street 1:3504 GLORIA AVE
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-8107
Practice Address - Country:US
Practice Address - Phone:928-419-1627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCADC00795-C101YA0400X
AZLISAC1619101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1437646429OtherNPI