Healthcare Provider Details

I. General information

NPI: 1710015896
Provider Name (Legal Business Name): SUSAN OSBORNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3633 E BROADWAY
LONG BEACH CA
90803-6035
US

IV. Provider business mailing address

200 PINE AVE STE 400
LONG BEACH CA
90802-3039
US

V. Phone/Fax

Practice location:
  • Phone: 562-419-5663
  • Fax:
Mailing address:
  • Phone: 562-285-1330
  • Fax: 562-263-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: