Provider Demographics
NPI:1598144610
Name:OWEN, RUTH ANNE (LMHC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:ANNE
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8440 STARDUST WAY
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-4364
Mailing Address - Country:US
Mailing Address - Phone:352-279-2734
Mailing Address - Fax:
Practice Address - Street 1:8440 STARDUST WAY
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-4364
Practice Address - Country:US
Practice Address - Phone:352-279-2734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23799101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health