Provider Demographics
NPI:1821785759
Name:OSBORN, JUSTIN CLAY
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CLAY
Last Name:OSBORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62895 HAMBY RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9575
Mailing Address - Country:US
Mailing Address - Phone:541-903-0987
Mailing Address - Fax:
Practice Address - Street 1:62895 HAMBY RD
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9575
Practice Address - Country:US
Practice Address - Phone:541-903-0987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker