Provider Demographics
NPI:1598155517
Name:OWEN, BRANDY LYNN
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:OWEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 S LAMB BLVD
Mailing Address - Street 2:TRLR 44
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1827
Mailing Address - Country:US
Mailing Address - Phone:575-518-9007
Mailing Address - Fax:
Practice Address - Street 1:8224 W CHARLESTON BLVD
Practice Address - Street 2:STE 1
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9096
Practice Address - Country:US
Practice Address - Phone:702-233-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health