Provider Demographics
NPI:1801160619
Name:OSBORN, DEBORAH MOORE (LCSW)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:MOORE
Last Name:OSBORN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:DEBORAH
Other - Middle Name:MOORE
Other - Last Name:BEAZLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:420 E MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1237
Mailing Address - Country:US
Mailing Address - Phone:304-319-1654
Mailing Address - Fax:
Practice Address - Street 1:420 E MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1237
Practice Address - Country:US
Practice Address - Phone:304-319-1654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-27
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP009433381041C0700X
IDLCSW-356511041C0700X
CA1207961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical