Provider Demographics
NPI:1811079700
Name:OSBORN, STEPHEN MARK (PH D)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARK
Last Name:OSBORN
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Gender:M
Credentials:PH D
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Mailing Address - Street 1:4601 BUFFALO GAP ROAD
Mailing Address - Street 2:SUITE C6
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606
Mailing Address - Country:US
Mailing Address - Phone:325-695-2232
Mailing Address - Fax:325-695-2233
Practice Address - Street 1:4601 BUFFALO GAP ROAD
Practice Address - Street 2:SUITE C6
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606
Practice Address - Country:US
Practice Address - Phone:325-695-2232
Practice Address - Fax:325-695-2233
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-10-21
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Provider Licenses
StateLicense IDTaxonomies
TX22414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114806601Medicaid