Provider Demographics
NPI:1902010325
Name:OWENZ, MEGHAN BRIDGET (PHD, ABPP)
Entity type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:BRIDGET
Last Name:OWENZ
Suffix:
Gender:F
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MARKETSIDE AVE
Mailing Address - Street 2:SUITE 404, BOX 172
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081
Mailing Address - Country:US
Mailing Address - Phone:904-373-8871
Mailing Address - Fax:
Practice Address - Street 1:416 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8558
Practice Address - Country:US
Practice Address - Phone:904-373-8871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12447103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling