Provider Demographics
NPI:1881281970
Name:OSBORNE, ANNA (LMFT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5256 CARLTON RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-4180
Mailing Address - Country:US
Mailing Address - Phone:229-560-3446
Mailing Address - Fax:
Practice Address - Street 1:1102 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31601-4041
Practice Address - Country:US
Practice Address - Phone:229-588-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMFT001710106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist