Provider Demographics
NPI:1417614967
Name:OWENS, MOLLY (LMHC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4114 FORRESTAL AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6171
Mailing Address - Country:US
Mailing Address - Phone:321-848-8424
Mailing Address - Fax:
Practice Address - Street 1:4114 FORRESTAL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6171
Practice Address - Country:US
Practice Address - Phone:321-848-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14241101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health