Provider Demographics
NPI:1487025763
Name:OSBURN, NATALIE SUZANNE (MA, LICENSED PSYCHOL)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:SUZANNE
Last Name:OSBURN
Suffix:
Gender:F
Credentials:MA, LICENSED PSYCHOL
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:SUZANNE
Other - Last Name:GRUNAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:P.O. BOX 299
Mailing Address - Street 2:252 COURTHOUSE DRIVE
Mailing Address - City:WINFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:25213-9370
Mailing Address - Country:US
Mailing Address - Phone:304-525-7851
Mailing Address - Fax:304-586-0671
Practice Address - Street 1:3375 US ROUTE 60, EAST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25705-2837
Practice Address - Country:US
Practice Address - Phone:304-525-7851
Practice Address - Fax:304-586-0671
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1120103TC0700X
WVAP00943840104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0005355002Medicaid
WV0005355002Medicaid