Active NPI
Bruce Willard Osborne Jr., LPC
- Professional Counselor
- La Grange, KY
National Provider Identifier
1710938782
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- KY-1524
- Practice address
- 1800 Zhale Smith Road
La Grange, KY 40031 - Phone
- (502) 264-1514
- Fax
- (502) 371-7550
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | KY-1524 | KY | Primary |
| Professional Counselor | 101YP2500X | LPC0000000736 | TN |
Addresses
Primary practice location
1800 Zhale Smith Road
La Grange, KY 40031
Mailing address
P O Box 514
La Grange, KY 40031
Phone (502) 264-1514
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 283910000 | Other | TN | MAGELLAN |
| 4058210 | Other | TN | BLUE CROSS BLUE SHIELD |
| 230204 | Other | TN | OPTUM EAP |
| 283910000 | Other | TN | AETNA |
| 5441054 | Medicaid | TN | |
| 11539066 | Other | TN | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| KY-1524 | KY | MD | Professional Counselor |
| LPC0000000736 | TN | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401840000000",
"number": "1710938782",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 514",
"city": "LA GRANGE",
"state": "KY",
"postal_code": "40031",
"telephone_number": "502-264-1514",
"fax_number": "502-371-7550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 ZHALE SMITH ROAD",
"city": "LA GRANGE",
"state": "KY",
"postal_code": "40031",
"telephone_number": "502-264-1514",
"fax_number": "502-371-7550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OSBORNE",
"first_name": "BRUCE",
"middle_name": "WILLARD",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2014-06-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "KY",
"license": "KY-1524",
"primary": true
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TN",
"license": "LPC0000000736",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "283910000",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4058210",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTUM EAP",
"identifier": "230204",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "283910000",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5441054",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11539066",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Grange, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.