Provider Demographics
NPI:1043577596
Name:OSBORNE, MILLA JANE (LPC)
Entity Type:Individual
Prefix:
First Name:MILLA
Middle Name:JANE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-1034
Mailing Address - Country:US
Mailing Address - Phone:801-399-1600
Mailing Address - Fax:801-399-1640
Practice Address - Street 1:3518 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1034
Practice Address - Country:US
Practice Address - Phone:801-399-1600
Practice Address - Fax:801-399-1640
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT80675046004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional