Provider Demographics
NPI:1770749681
Name:OSBORN, SHELLEY NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:NICOLE
Last Name:OSBORN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NW 13TH AVE APT 304
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2935
Mailing Address - Country:US
Mailing Address - Phone:707-860-3265
Mailing Address - Fax:
Practice Address - Street 1:416 NW 13TH AVE APT 304
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2935
Practice Address - Country:US
Practice Address - Phone:707-860-3265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR25-QMHP-R-3500101YM0800X
CAPSY28074103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health