Provider Demographics
NPI:1306055983
Name:OSBURN, RICHARD L (LMSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:L
Last Name:OSBURN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRIAR LN
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642-3045
Mailing Address - Country:US
Mailing Address - Phone:989-631-7429
Mailing Address - Fax:
Practice Address - Street 1:5400 FRIAR LN
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642-3045
Practice Address - Country:US
Practice Address - Phone:989-631-7429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010002081041C0700X
MI4101005058106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist