Healthcare Provider Details

I. General information

NPI: 1740143676
Provider Name (Legal Business Name): CHRISTOPHER OSBORN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 40TH AVE S
MOORHEAD MN
56560-7416
US

IV. Provider business mailing address

1504 E MOUNT FAITH AVE
FERGUS FALLS MN
56537-2311
US

V. Phone/Fax

Practice location:
  • Phone: 218-284-5472
  • Fax:
Mailing address:
  • Phone: 218-284-5472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number412927
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: