Provider Demographics
NPI:1336869981
Name:OSBORNE PSYCHIATRY AND WELLNESS, LLC
Entity Type:Organization
Organization Name:OSBORNE PSYCHIATRY AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:206-793-7168
Mailing Address - Street 1:40 LAKE BELLEVUE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2480
Mailing Address - Country:US
Mailing Address - Phone:206-793-7168
Mailing Address - Fax:
Practice Address - Street 1:40 LAKE BELLEVUE DR STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2480
Practice Address - Country:US
Practice Address - Phone:206-793-7168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1518555283.OtherNPI-1
WAMO7720306OtherDEA