Provider Demographics
NPI:1578192621
Name:CARIN OSVOG, LLC
Entity Type:Organization
Organization Name:CARIN OSVOG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:CARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OSVOG
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:612-910-4773
Mailing Address - Street 1:7165 STRATFORD RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2712
Mailing Address - Country:US
Mailing Address - Phone:612-910-4773
Mailing Address - Fax:
Practice Address - Street 1:700 COMMERCE DR STE 295
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-9245
Practice Address - Country:US
Practice Address - Phone:651-571-2865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health