Provider Demographics
NPI:1942737812
Name:OSBORNE, KYLEN A
Entity Type:Individual
Prefix:
First Name:KYLEN
Middle Name:A
Last Name:OSBORNE
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 1:2267 S GENEVA AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-4326
Mailing Address - Country:US
Mailing Address - Phone:559-266-6449
Mailing Address - Fax:559-266-2101
Practice Address - Street 1:2267 S GENEVA AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-4326
Practice Address - Country:US
Practice Address - Phone:559-266-6449
Practice Address - Fax:559-266-2101
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)