Provider Demographics
NPI:1295826931
Name:OSBORN, SETH RAYMOND (LSCSW)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:RAYMOND
Last Name:OSBORN
Suffix:
Gender:M
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 W ZOO BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1620
Mailing Address - Country:US
Mailing Address - Phone:316-749-2007
Mailing Address - Fax:316-943-5554
Practice Address - Street 1:4425 W ZOO BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1620
Practice Address - Country:US
Practice Address - Phone:316-749-2007
Practice Address - Fax:316-943-5554
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS41991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical