Provider Demographics
NPI:1609103159
Name:OWEN, WILLIAM ROBERT (CADC-II)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROBERT
Last Name:OWEN
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CADC II
Mailing Address - Street 1:4375 E CALLE DE RICARDO
Mailing Address - Street 2:SUITE B
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1448
Mailing Address - Country:US
Mailing Address - Phone:310-999-2873
Mailing Address - Fax:
Practice Address - Street 1:4375 E CALLE DE RICARDO
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1448
Practice Address - Country:US
Practice Address - Phone:310-999-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA827198101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor