Patrick Joseph Osmonson, LISAC, CCTP

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LISAC1619 Issued in AZ

Practice address

3504 Gloria Ave
Bullhead City, AZ 86442-8107

Phone

(928) 419-1627

NPI assigned

Apr 16, 2018

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615852800000",
    "number": "1437646429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3504 GLORIA AVE",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864428107",
            "telephone_number": "928-419-1627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3504 GLORIA AVE",
            "city": "BULLHEAD CITY",
            "state": "AZ",
            "postal_code": "864428107",
            "telephone_number": "928-419-1627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OSMONSON",
        "first_name": "PATRICK",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "credential": "LISAC, CCTP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-16",
        "last_updated": "2021-03-16",
        "certification_date": "2021-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NV",
            "license": "CADC00795-C",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "AZ",
            "license": "LISAC1619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1437646429",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Addiction (Substance Use Disorder) Counselor in Bullhead City, AZ
• Providers in Bullhead City, AZ by specialty
• Addiction (Substance Use Disorder) Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.