Provider Demographics
NPI:1689385205
Name:OSLUND, JEFFREY EMIL (LAC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EMIL
Last Name:OSLUND
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 LION TRL
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8436
Mailing Address - Country:US
Mailing Address - Phone:301-741-0485
Mailing Address - Fax:
Practice Address - Street 1:285 2ND AVE WN
Practice Address - Street 2:STE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-890-2570
Practice Address - Fax:406-316-6186
Is Sole Proprietor?:No
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-51583101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)