Provider Demographics
NPI:1689490955
Name:OSARENIYE, OSAGIE (LCDC)
Entity type:Individual
Prefix:
First Name:OSAGIE
Middle Name:
Last Name:OSARENIYE
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8850 FERGUSON RD APT 3045
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-8325
Mailing Address - Country:US
Mailing Address - Phone:972-757-2200
Mailing Address - Fax:
Practice Address - Street 1:1813 HARWOOD CT
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3190
Practice Address - Country:US
Practice Address - Phone:866-287-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)