Healthcare Provider Details

I. General information

NPI: 1962482471
Provider Name (Legal Business Name): PHILIP L OSBORNE LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 CRAWFORD AVE SUITE 304
EVANSTON IL
60201-4970
US

IV. Provider business mailing address

2530 CRAWFORD AVE SUITE 304
EVANSTON IL
60201-4970
US

V. Phone/Fax

Practice location:
  • Phone: 847-424-9433
  • Fax: 847-869-8116
Mailing address:
  • Phone: 847-424-9433
  • Fax: 847-869-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: