Provider Demographics
NPI:1841370889
Name:OSBURN, TAMI LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:TAMI
Middle Name:LYNN
Last Name:OSBURN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:TAMI
Other - Middle Name:LYNN
Other - Last Name:RISAVI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1512
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88311-1512
Mailing Address - Country:US
Mailing Address - Phone:402-350-0612
Mailing Address - Fax:
Practice Address - Street 1:1123 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6340
Practice Address - Country:US
Practice Address - Phone:575-415-9270
Practice Address - Fax:208-978-7050
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-063101041C0700X
NMC-063101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM79206352Medicaid