Healthcare Provider Details

I. General information

NPI: 1669045209
Provider Name (Legal Business Name): HEATHER OSBORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14532 ST. RT. 23
WAVERLY OH
45690
US

IV. Provider business mailing address

17 UMBLEBEE RD
BEAVER OH
45613-9634
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-2364
  • Fax:
Mailing address:
  • Phone: 740-970-1747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: