Provider Demographics
NPI:1588639546
Name:OSBORN, STEVEN L (PHD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:OSBORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:STEVEN
Other - Middle Name:L
Other - Last Name:OSBORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:805 S CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2344
Mailing Address - Country:US
Mailing Address - Phone:231-775-6517
Mailing Address - Fax:231-775-6587
Practice Address - Street 1:805 S CARMEL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2344
Practice Address - Country:US
Practice Address - Phone:231-775-6517
Practice Address - Fax:231-775-6587
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301004078103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MISO004078Medicare UPIN
OM27300004Medicare ID - Type Unspecified