Provider Demographics
NPI:1497399034
Name:OSBORN, DALE LAUREN (ASSOCIATE CLINICAL S)
Entity Type:Individual
Prefix:MS
First Name:DALE
Middle Name:LAUREN
Last Name:OSBORN
Suffix:
Gender:F
Credentials:ASSOCIATE CLINICAL S
Other - Prefix:MS
Other - First Name:DAYLE
Other - Middle Name:LAUREN
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ASSOCIATE CLINICAL S
Mailing Address - Street 1:202 EAST BIXBY ROAD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807
Mailing Address - Country:US
Mailing Address - Phone:562-212-7382
Mailing Address - Fax:
Practice Address - Street 1:1501 HUGHES WAY
Practice Address - Street 2:STE. 100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:562-548-6565
Practice Address - Fax:562-685-0426
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA94293104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor