Provider Demographics
NPI:1992470785
Name:OWENS, DEIRDRE (CPC-I)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 BIG BEND WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-4155
Mailing Address - Country:US
Mailing Address - Phone:714-501-7511
Mailing Address - Fax:
Practice Address - Street 1:2915 W CHARLESTON BLVD STE 175
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1939
Practice Address - Country:US
Practice Address - Phone:702-823-3910
Practice Address - Fax:702-823-1313
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI5029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional