Provider Demographics
NPI:1366502890
Name:OSGOOD, TY WILLIAM (LPC)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:WILLIAM
Last Name:OSGOOD
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9586
Mailing Address - Country:US
Mailing Address - Phone:417-624-0570
Mailing Address - Fax:417-624-0996
Practice Address - Street 1:811 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-9586
Practice Address - Country:US
Practice Address - Phone:417-624-0570
Practice Address - Fax:417-624-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002001279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional