Provider Demographics
NPI:1164614640
Name:OWEN, ANNE BURNHAM (LCPC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BURNHAM
Last Name:OWEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:1704 W BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4058
Mailing Address - Country:US
Mailing Address - Phone:406-587-7515
Mailing Address - Fax:
Practice Address - Street 1:1704 W BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4058
Practice Address - Country:US
Practice Address - Phone:406-587-7515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT645106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist