Provider Demographics
NPI:1265457477
Name:OWENS, STEPHEN JEROME (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JEROME
Last Name:OWENS
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2331
Mailing Address - Country:US
Mailing Address - Phone:740-593-7314
Mailing Address - Fax:740-594-2804
Practice Address - Street 1:510 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2331
Practice Address - Country:US
Practice Address - Phone:740-593-7314
Practice Address - Fax:740-594-2804
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304616Medicaid
OHOWCP25513Medicare ID - Type UnspecifiedPSYCHOLOGIST