Healthcare Provider Details

I. General information

NPI: 1093045320
Provider Name (Legal Business Name): TOBY W OSBURN L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

194 WILLIAMSBURG ST HERITAGE SQUARE OFFICE PARK, BLDG. B
LAKE CHARLES LA
70605-5720
US

IV. Provider business mailing address

PO BOX 4755
LAKE CHARLES LA
70606-4755
US

V. Phone/Fax

Practice location:
  • Phone: 337-912-9026
  • Fax:
Mailing address:
  • Phone: 337-912-9026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4518
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19228
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: