Provider Demographics
NPI:1730141722
Name:OSBORNE, CATHERINE CANNON (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:CANNON
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-8800
Mailing Address - Fax:
Practice Address - Street 1:7700 FISH POND RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-1031
Practice Address - Country:US
Practice Address - Phone:254-761-4408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30861103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX680012682OtherRR/MEDICARE
TX86454AOtherBLUE SHIELD
TX0410805-01Medicaid
TX82952PMedicare ID - Type Unspecified
TX0410805-01Medicaid