Provider Demographics
NPI:1386618262
Name:OSBORNE, AMY DIANE (LPCC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:DIANE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 518
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-865-3350
Mailing Address - Fax:
Practice Address - Street 1:739 DON PASQUAL
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-865-3350
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0061601101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62082884Medicaid