Provider Demographics
NPI:1558442491
Name:OWEN, MARY KATHRYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KATHRYN
Last Name:OWEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-7244
Mailing Address - Country:US
Mailing Address - Phone:512-491-8444
Mailing Address - Fax:512-491-0226
Practice Address - Street 1:1433 FAIRFIELD DR
Practice Address - Street 2:HILL COUNTRY COUNSELING
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7244
Practice Address - Country:US
Practice Address - Phone:512-491-8444
Practice Address - Fax:512-491-0226
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX322561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142064802Medicaid
TX142064802Medicaid
P27114Medicare UPIN