Provider Demographics
NPI:1508552316
Name:OSBORN, TERRA D (MED)
Entity Type:Individual
Prefix:
First Name:TERRA
Middle Name:D
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 THORN OAK DR SPC 9
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-1873
Mailing Address - Country:US
Mailing Address - Phone:360-448-5467
Mailing Address - Fax:
Practice Address - Street 1:2552 THORN OAK DR SPC 9
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-1873
Practice Address - Country:US
Practice Address - Phone:360-448-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health