MEDICARE: MS. CARIN JULIANNE OSVOG LPCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	CC00959	MN

General Provider Information

NPI Number	:	1922493949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARIN JULIANNE OSVOG LPCC

Provider Business Mailing Address
First Line	:	2324 UNIVERSITY AVE W STE 120
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-644-4885
Fax Number	:	651-628-0411

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W STE 120
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-644-4885
Fax Number	:	651-644-4885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2015
Last Update Date	:	07/19/2019

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