Healthcare Provider Details

I. General information

NPI: 1245094317
Provider Name (Legal Business Name): CAROL OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 S LANSING ST
MASON MI
48854-1917
US

IV. Provider business mailing address

1224 JEWELL RD
MILAN MI
48160
US

V. Phone/Fax

Practice location:
  • Phone: 517-930-3071
  • Fax:
Mailing address:
  • Phone: 734-645-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401018040
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: