Provider Demographics
NPI:1710446216
Name:OSBORNE, JAMES JOSEPH (LCPC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 MASTERSON CIR
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5293
Mailing Address - Country:US
Mailing Address - Phone:208-227-4769
Mailing Address - Fax:
Practice Address - Street 1:500 S 11TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4835
Practice Address - Country:US
Practice Address - Phone:254-778-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2025-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6726101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85261OtherTEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL
IDLCPC-6726OtherIDAHO LICENSING BOARD OF PROFESSIONAL COUNSELORS & MARRIAGE & FAMILY THERAPISTS