Provider Demographics
NPI:1083860803
Name:OSBORN, O'NIELL GREENLEAF (MED)
Entity Type:Individual
Prefix:MR
First Name:O'NIELL
Middle Name:GREENLEAF
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SUNNYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-3076
Mailing Address - Country:US
Mailing Address - Phone:541-337-3805
Mailing Address - Fax:
Practice Address - Street 1:272 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3031
Practice Address - Country:US
Practice Address - Phone:541-653-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4448101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional