Provider Demographics
NPI:1427197540
Name:OWENS, TRAVIS H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:H
Last Name:OWENS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1891 EAST ROSEVILLE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:95661-7979
Mailing Address - Country:US
Mailing Address - Phone:916-789-7083
Mailing Address - Fax:916-797-8840
Practice Address - Street 1:1891 EAST ROSEVILLE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ROSEVILLE
Practice Address - State:CT
Practice Address - Zip Code:95661-7979
Practice Address - Country:US
Practice Address - Phone:916-789-7083
Practice Address - Fax:916-797-8840
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PL83030Medicare ID - Type Unspecified