Healthcare Provider Details

I. General information

NPI: 1114329752
Provider Name (Legal Business Name): LOUISE OSBORN LM, CPM, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SHIRLEYS WAY
ST AUGUSTINE FL
32086-5888
US

IV. Provider business mailing address

205 SHIRLEYS WAY STE 104
ST AUGUSTINE FL
32086-5888
US

V. Phone/Fax

Practice location:
  • Phone: 904-349-5993
  • Fax:
Mailing address:
  • Phone: 904-349-5993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH14826
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW438
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: