Provider Demographics
NPI:1306171723
Name:DEEDS, OSVELIA GONZALEZ (PHD)
Entity type:Individual
Prefix:DR
First Name:OSVELIA
Middle Name:GONZALEZ
Last Name:DEEDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:OSVELIA
Other - Middle Name:G
Other - Last Name:DEEDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLC
Mailing Address - Street 1:PO BOX 62384
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89006-2384
Mailing Address - Country:US
Mailing Address - Phone:505-850-5314
Mailing Address - Fax:928-438-2037
Practice Address - Street 1:2580 HIGHWAY 95 STE 213G
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7331
Practice Address - Country:US
Practice Address - Phone:505-850-5314
Practice Address - Fax:928-438-2037
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-04
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1095103TC0700X
FLPY7898103TC0700X
AZ4693103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ185237OtherMEDICARE PTAN
NM17031124823Medicaid
AZ099268Medicaid
AZZ185237OtherMEDICARE PTAN