Provider Demographics
NPI:1821014614
Name:OSBORNE, RETA M (M ED LPC)
Entity Type:Individual
Prefix:
First Name:RETA
Middle Name:M
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:M ED LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 W GARRIOTT RD
Mailing Address - Street 2:BUILDING 1
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-5751
Mailing Address - Country:US
Mailing Address - Phone:580-237-2884
Mailing Address - Fax:580-237-9228
Practice Address - Street 1:1420 W GARRIOTT RD
Practice Address - Street 2:BUILDING 1
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-5751
Practice Address - Country:US
Practice Address - Phone:580-237-2884
Practice Address - Fax:580-237-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health