Provider Demographics
NPI:1871349860
Name:OSTERBAUER, MONICA CLARE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:CLARE
Last Name:OSTERBAUER
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 1:3223 S LOOP 289 STE 320
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-1367
Mailing Address - Country:US
Mailing Address - Phone:806-705-8833
Mailing Address - Fax:
Practice Address - Street 1:3223 S LOOP 289 STE 320
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-1367
Practice Address - Country:US
Practice Address - Phone:806-705-8833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205415106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist