Provider Demographics
NPI:1700515111
Name:DUZAN-OSBORN, KATIE LEE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LEE
Last Name:DUZAN-OSBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 N TEA OLIVE WAY
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-2220
Mailing Address - Country:US
Mailing Address - Phone:405-320-1736
Mailing Address - Fax:
Practice Address - Street 1:1000 W WILSHIRE BLVD STE 224
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7020
Practice Address - Country:US
Practice Address - Phone:405-320-1736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health