Provider Demographics
NPI:1548777360
Name:OWEN, CERYS E (BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:CERYS
Middle Name:E
Last Name:OWEN
Suffix:
Gender:F
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E WILSON BRIDGE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-2391
Mailing Address - Country:US
Mailing Address - Phone:614-615-5145
Mailing Address - Fax:
Practice Address - Street 1:130 E WILSON BRIDGE RD STE 200
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-2391
Practice Address - Country:US
Practice Address - Phone:301-910-3408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
OH1-22-59323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst