Provider Demographics
NPI:1962482471
Name:OSBORNE, PHILIP L (LCPC)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:L
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CRAWFORD AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4970
Mailing Address - Country:US
Mailing Address - Phone:847-424-9433
Mailing Address - Fax:847-869-8116
Practice Address - Street 1:2530 CRAWFORD AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4970
Practice Address - Country:US
Practice Address - Phone:847-424-9433
Practice Address - Fax:847-869-8116
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health