Provider Demographics
NPI:1093045320
Name:OSBURN, TOBY W (LPC)
Entity type:Individual
Prefix:
First Name:TOBY
Middle Name:W
Last Name:OSBURN
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:PO BOX 4755
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4755
Mailing Address - Country:US
Mailing Address - Phone:337-912-9026
Mailing Address - Fax:
Practice Address - Street 1:194 WILLIAMSBURG ST
Practice Address - Street 2:HERITAGE SQUARE OFFICE PARK, BLDG. B
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5720
Practice Address - Country:US
Practice Address - Phone:337-912-9026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4518101YP2500X
TX19228101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional