Provider Demographics
NPI:1083198634
Name:OWENS, BRANDON NEIL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:NEIL
Last Name:OWENS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 AVENIDA ADOBE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2408
Mailing Address - Country:US
Mailing Address - Phone:562-480-6650
Mailing Address - Fax:
Practice Address - Street 1:24800 CHRISANTA DR STE 120
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-4839
Practice Address - Country:US
Practice Address - Phone:562-480-6650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT98698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist