Provider Demographics
NPI:1417360264
Name:OWENS, JESSICA (PCC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8559 S MASON MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-9381
Mailing Address - Country:US
Mailing Address - Phone:513-229-8980
Mailing Address - Fax:513-229-8935
Practice Address - Street 1:90 RHOADS CENTER DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-3859
Practice Address - Country:US
Practice Address - Phone:937-291-3342
Practice Address - Fax:937-999-2467
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0501043101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional