Provider Demographics
NPI:1588670210
Name:OWENS, STEPHEN L (PSYD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:OWENS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3751
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3751
Mailing Address - Country:US
Mailing Address - Phone:423-341-6898
Mailing Address - Fax:423-952-2272
Practice Address - Street 1:302 SUNSET DR STE 106
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2408
Practice Address - Country:US
Practice Address - Phone:423-341-6898
Practice Address - Fax:423-952-2272
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3689319Medicare ID - Type Unspecified