Provider Demographics
NPI:1053122218
Name:OSBORNE, VALERIE LYNDA
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:LYNDA
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 HOLLOWAY ST
Mailing Address - Street 2:
Mailing Address - City:WALHALLA
Mailing Address - State:SC
Mailing Address - Zip Code:29691-1515
Mailing Address - Country:US
Mailing Address - Phone:561-254-7861
Mailing Address - Fax:
Practice Address - Street 1:428 HOLLOWAY ST
Practice Address - Street 2:
Practice Address - City:WALHALLA
Practice Address - State:SC
Practice Address - Zip Code:29691-1515
Practice Address - Country:US
Practice Address - Phone:561-254-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106004749103K00000X
SC4174103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst