Provider Demographics
NPI:1275762452
Name:TRAVIS H. OWENS, PSY.D. INC.
Entity Type:Organization
Organization Name:TRAVIS H. OWENS, PSY.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:916-789-7082
Mailing Address - Street 1:1891 E ROSEVILLE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7974
Mailing Address - Country:US
Mailing Address - Phone:916-789-7082
Mailing Address - Fax:916-797-8840
Practice Address - Street 1:1891 E ROSEVILLE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7974
Practice Address - Country:US
Practice Address - Phone:916-789-7082
Practice Address - Fax:916-797-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL83030Medicare PIN