Provider Demographics
NPI:1184076341
Name:OSBORNE, ADAM RUSSELL (LPC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:RUSSELL
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 BEECHMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-9518
Mailing Address - Country:US
Mailing Address - Phone:989-400-0207
Mailing Address - Fax:
Practice Address - Street 1:5985 W MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8708
Practice Address - Country:US
Practice Address - Phone:269-459-9790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013311101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional