Provider Demographics
NPI:1235185422
Name:OWENS, MICHAEL EDWARD HALL II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:EDWARD HALL
Last Name:OWENS
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1303
Mailing Address - Street 2:
Mailing Address - City:QUECHEE
Mailing Address - State:VT
Mailing Address - Zip Code:05059-1303
Mailing Address - Country:US
Mailing Address - Phone:802-369-4876
Mailing Address - Fax:
Practice Address - Street 1:119 UNDERHILL LANE
Practice Address - Street 2:
Practice Address - City:QUECHEE
Practice Address - State:VT
Practice Address - Zip Code:05059-1303
Practice Address - Country:US
Practice Address - Phone:802-369-4876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSW-10608I1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6707017Medicaid