Provider Demographics
NPI:1053969675
Name:OSBORNE, MICHAEL ALLEN (LPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALLEN
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 W BRANDT BLVD
Mailing Address - Street 2:
Mailing Address - City:SALUNGA
Mailing Address - State:PA
Mailing Address - Zip Code:17538-1105
Mailing Address - Country:US
Mailing Address - Phone:717-220-8968
Mailing Address - Fax:
Practice Address - Street 1:45 W BRANDT BLVD
Practice Address - Street 2:
Practice Address - City:SALUNGA
Practice Address - State:PA
Practice Address - Zip Code:17538-1105
Practice Address - Country:US
Practice Address - Phone:717-220-8968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011475101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional