Provider Demographics
NPI:1154649994
Name:OSBURN, KELLI LYNN (BSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:OSBURN
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 N OAKWOOD RD
Mailing Address - Street 2:APT 12B
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3701
Mailing Address - Country:US
Mailing Address - Phone:580-231-0500
Mailing Address - Fax:
Practice Address - Street 1:210 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-4114
Practice Address - Country:US
Practice Address - Phone:580-234-4474
Practice Address - Fax:580-233-6739
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker