Provider Demographics
NPI:1841451457
Name:SMITH-OSBORNE, ALEXA MARTIN (LCSW)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:MARTIN
Last Name:SMITH-OSBORNE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S COOPER ST
Mailing Address - Street 2:BOX 19129
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0001
Mailing Address - Country:US
Mailing Address - Phone:817-272-0452
Mailing Address - Fax:817-272-2028
Practice Address - Street 1:803 STADIUM DR STE 101
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-6246
Practice Address - Country:US
Practice Address - Phone:817-459-2003
Practice Address - Fax:817-459-1898
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32761041C0700X
MELC195261041C0700X
WVDP009458791041C0700X
TX501071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ698OtherBLUE CROSS BLUE SHIELD