Provider Demographics
NPI:1124629845
Name:OWENS, DANIEL WINFORD (TLAC)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WINFORD
Last Name:OWENS
Suffix:
Gender:M
Credentials:TLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4935
Mailing Address - Country:US
Mailing Address - Phone:316-558-3066
Mailing Address - Fax:316-558-3067
Practice Address - Street 1:212 N HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-4935
Practice Address - Country:US
Practice Address - Phone:316-558-3066
Practice Address - Fax:316-558-3067
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1698101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)