Individual
MARY ELLEN OSBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001519A
IN
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
34006478A
IN
Other
Enumeration date
06/15/2011
Last updated
08/18/2022
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