Provider Demographics
NPI:1972678365
Name:OSBORNE, BEVERLY G (LPC)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:G
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 W MAIN ST
Mailing Address - Street 2:410 W MAIN ST
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028
Mailing Address - Country:US
Mailing Address - Phone:636-933-9590
Mailing Address - Fax:636-933-9641
Practice Address - Street 1:410 W MAIN ST
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-933-9590
Practice Address - Fax:636-933-9641
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493364517Medicaid