Provider Demographics
NPI:1114658549
Name:OWEN CLINIC
Entity Type:Organization
Organization Name:OWEN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR, CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVON
Authorized Official - Middle Name:
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DCOUN
Authorized Official - Phone:405-740-1249
Mailing Address - Street 1:12901 E BRITTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:JONES
Mailing Address - State:OK
Mailing Address - Zip Code:73049-7407
Mailing Address - Country:US
Mailing Address - Phone:405-740-1249
Mailing Address - Fax:405-399-2471
Practice Address - Street 1:12901 E BRITTON RD STE B
Practice Address - Street 2:
Practice Address - City:JONES
Practice Address - State:OK
Practice Address - Zip Code:73049-7407
Practice Address - Country:US
Practice Address - Phone:405-740-1249
Practice Address - Fax:405-399-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty