Provider Demographics
NPI:1720731896
Name:OSBORNE, JAYCIE KAYLE
Entity Type:Individual
Prefix:
First Name:JAYCIE
Middle Name:KAYLE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2681 MACARTHUR BLVD STE 302
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-8260
Mailing Address - Country:US
Mailing Address - Phone:469-389-1123
Mailing Address - Fax:
Practice Address - Street 1:2681 MACARTHUR BLVD STE 302
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-8260
Practice Address - Country:US
Practice Address - Phone:469-389-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-30
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87968101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty