Provider Demographics
NPI:1558998419
Name:OWENS, THOMAS EDWARD III (BA, CGCS, ICADC, SAP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDWARD
Last Name:OWENS
Suffix:III
Gender:M
Credentials:BA, CGCS, ICADC, SAP
Other - Prefix:MR
Other - First Name:TOMMY
Other - Middle Name:EDWARD
Other - Last Name:OWENS
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:BA, CGCS, ICADC, SAP
Mailing Address - Street 1:706 ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AR
Mailing Address - Zip Code:72949-9789
Mailing Address - Country:US
Mailing Address - Phone:479-209-0661
Mailing Address - Fax:
Practice Address - Street 1:706 ALSTON ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AR
Practice Address - Zip Code:72949-9789
Practice Address - Country:US
Practice Address - Phone:479-209-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR174114101YA0400X
AR2130101YA0400X
AR829792101YA0400X
ARSAP174114101YM0800X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health