Provider Demographics
NPI:1942078100
Name:OSBORN, KRISTIE LLG
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LLG
Last Name:OSBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45521 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-4211
Mailing Address - Country:US
Mailing Address - Phone:916-770-1622
Mailing Address - Fax:
Practice Address - Street 1:1035 BELVIDERE ST STE 123
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2433
Practice Address - Country:US
Practice Address - Phone:915-642-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician