Provider Demographics
NPI:1417010547
Name:OWEN, CURTIS RAY (MED)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:RAY
Last Name:OWEN
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W MAIN ST
Mailing Address - Street 2:SUITE #324
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-6337
Mailing Address - Country:US
Mailing Address - Phone:580-226-9222
Mailing Address - Fax:580-226-9226
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:SUITE #324
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-6337
Practice Address - Country:US
Practice Address - Phone:580-226-9222
Practice Address - Fax:580-226-9226
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health