Provider Demographics
NPI:1437615507
Name:OWENS, SUZANNA VICTORIA (LPC/MHSP/NCC)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNA
Middle Name:VICTORIA
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPC/MHSP/NCC
Other - Prefix:MRS
Other - First Name:SUZANNA
Other - Middle Name:VICTORIA
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JOHNSON
Mailing Address - Street 1:2673 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3335
Mailing Address - Country:US
Mailing Address - Phone:901-567-0415
Mailing Address - Fax:
Practice Address - Street 1:6551 STAGE OAKS DR STE 4
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3895
Practice Address - Country:US
Practice Address - Phone:901-387-0026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional