Provider Demographics
NPI:1164848446
Name:OWENS, CRYSTAL (BA)
Entity Type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E CARL ALBERT PKWY
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5037
Mailing Address - Country:US
Mailing Address - Phone:918-426-3334
Mailing Address - Fax:918-426-3336
Practice Address - Street 1:17 E CARL ALBERT PKWY
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-5037
Practice Address - Country:US
Practice Address - Phone:918-426-3334
Practice Address - Fax:918-426-3336
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100709660OtherSC PROVIDER NUMBER
OK1689761827OtherOK HEALTH CARE AUTHORITY PROVIDER NUMBER