Provider Demographics
NPI:1275686578
Name:OWENS, THERESA M (MSW)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:OWENS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3114 SUTTON BLVD
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3910
Mailing Address - Country:US
Mailing Address - Phone:314-781-7900
Mailing Address - Fax:314-781-7914
Practice Address - Street 1:3114 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3910
Practice Address - Country:US
Practice Address - Phone:314-781-7900
Practice Address - Fax:314-781-7914
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002875101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0050046694OtherMHNET
MO113456OtherMERCY UNITY
MO167552OtherANTHAM BCBS
MO0791113OtherBSHCN TBI CO