Provider Demographics
NPI:1891188843
Name:OSBORNE, TYSHA (MS, LCMFT)
Entity Type:Individual
Prefix:
First Name:TYSHA
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MS, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 STONEDALE DR
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-0325
Mailing Address - Country:US
Mailing Address - Phone:630-220-8825
Mailing Address - Fax:
Practice Address - Street 1:1506 BROWNING PL STE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7484
Practice Address - Country:US
Practice Address - Phone:630-220-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist