Provider Demographics
NPI:1114201357
Name:OWEN, PAUL A (CPAF, MS)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:A
Last Name:OWEN
Suffix:
Gender:M
Credentials:CPAF, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3172
Mailing Address - Country:US
Mailing Address - Phone:270-826-8761
Mailing Address - Fax:270-826-8737
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3172
Practice Address - Country:US
Practice Address - Phone:270-826-8761
Practice Address - Fax:270-826-8737
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-15103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical