Provider Demographics
NPI:1811484421
Name:OSGOOD, MARJA LIISA (MA, MFT INTERN)
Entity type:Individual
Prefix:MRS
First Name:MARJA
Middle Name:LIISA
Last Name:OSGOOD
Suffix:
Gender:F
Credentials:MA, MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 W HUFFAKER LN STE 303
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-2091
Mailing Address - Country:US
Mailing Address - Phone:775-852-0587
Mailing Address - Fax:
Practice Address - Street 1:180 W HUFFAKER LN STE 303
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-2091
Practice Address - Country:US
Practice Address - Phone:775-852-0587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVM10888106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist