Active NPI
Carol L. O'Saben, LP
- Clinical Psychologist
- Flagstaff, AZ
National Provider Identifier
1174592380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4292
- Practice address
- 4289 Canyon Loop
Flagstaff, AZ 86005-3726 - Phone
- (828) 773-7522
- NPI assigned
- Mar 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2868 | NC | |
| Clinical Psychologist | 103TC0700X | 4292 | AZ | Primary |
Addresses
Primary practice location
4289 Canyon Loop
Flagstaff, AZ 86005-3726
Mailing address
4289 Canyon Loop
Flagstaff, AZ 86005-3726
Phone (828) 773-7522
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6000806 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 1, 2023 through Nov 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4292 | AZ | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511654400000",
"number": "1174592380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4289 CANYON LOOP",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860053726",
"telephone_number": "828-773-7522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4289 CANYON LOOP",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860053726",
"telephone_number": "828-773-7522"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'SABEN",
"first_name": "CAROL",
"middle_name": "L.",
"name_prefix": "Dr.",
"credential": "LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-17",
"last_updated": "2017-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "2868",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "4292",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6000806",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.