Individual
MR. COY R OSGOOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW, CDP
Contact information
Practice address
110 2ND ST S, STE 221, WAITE PARK, MN 56387-1662
(320) 345-1987
Mailing address
6240 COUNTY ROAD 120, APT 315, SAINT CLOUD, MN 56303-4890
(320) 345-1987
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
CP60065645
WA
101YM0800X
Mental Health Counselor
Primary
LGSW 25811
MN
101YM0800X
Mental Health Counselor
SC60229390
WA
Other
Enumeration date
06/11/2013
Last updated
03/27/2017
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