Provider Demographics
NPI:1497193593
Name:OSGOOD, COY R (MSW, LICSW, CDP)
Entity Type:Individual
Prefix:MR
First Name:COY
Middle Name:R
Last Name:OSGOOD
Suffix:
Gender:M
Credentials:MSW, LICSW, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6240 COUNTY ROAD 120
Mailing Address - Street 2:APT 315
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4890
Mailing Address - Country:US
Mailing Address - Phone:320-345-1987
Mailing Address - Fax:
Practice Address - Street 1:110 2ND ST S
Practice Address - Street 2:STE 221
Practice Address - City:WAITE PARK
Practice Address - State:MN
Practice Address - Zip Code:56387-1662
Practice Address - Country:US
Practice Address - Phone:320-345-1987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60065645101YA0400X
WASC60229390101YM0800X
MNLGSW 25811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)