Provider Demographics
NPI:1215598149
Name:OSBORNE, HOLLY (LMSW)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N AMIDON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-2137
Mailing Address - Country:US
Mailing Address - Phone:316-745-2563
Mailing Address - Fax:316-932-1556
Practice Address - Street 1:1900 N AMIDON AVE STE 210
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2137
Practice Address - Country:US
Practice Address - Phone:316-745-2563
Practice Address - Fax:316-932-1556
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS7382104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker