Provider Demographics
NPI:1114329752
Name:OSBORN, LOUISE (LM, CPM, LMHC)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LM, CPM, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 SHIRLEYS WAY STE 104
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5888
Mailing Address - Country:US
Mailing Address - Phone:904-349-5993
Mailing Address - Fax:
Practice Address - Street 1:205 SHIRLEYS WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5888
Practice Address - Country:US
Practice Address - Phone:904-349-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14826101YM0800X
FLMW438176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health