Provider Demographics
NPI:1568411569
Name:OWENS, GAYLE RENEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:RENEE
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 W LYNN ST
Mailing Address - Street 2:STE 1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4782
Mailing Address - Country:US
Mailing Address - Phone:512-306-9944
Mailing Address - Fax:512-236-9027
Practice Address - Street 1:913 W LYNN ST
Practice Address - Street 2:STE 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4782
Practice Address - Country:US
Practice Address - Phone:512-306-9944
Practice Address - Fax:512-236-9027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00K32HOtherBC/BS PROVDER NUMBER
TX00K32HOtherBC/BS PROVDER NUMBER