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NPI Code Detail

MEDICARE: QUINTON A OSBORNE LSW,

MEDICARE: QUINTON A OSBORNE LSW,
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.131023
2101YM0800XMental Health Counselor
3101YM0800XMental Health CounselorS.0020298

General Provider Information

NPI Number : 1528629789
Entity Type Code : Individual
Provider Name (Legal Business Name) : QUINTON A OSBORNE LSW,
Provider Business Mailing Address
First Line : 2611 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-1833
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 220 S BREIEL BLVD
Second Line :
City : MIDDLETOWN
State : OH
Zip : 45044-5106
Country : US
Telephone Number : 513-849-8670
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2019
Last Update Date : 05/18/2023

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Directions to “ QUINTON A OSBORNE LSW,” Practice Location

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