Provider Demographics
NPI:1629616859
Name:OWENS, CRYSTAL RENEE'
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:RENEE'
Last Name:OWENS
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 1:103 CONTINENTAL PL STE 120
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1086
Mailing Address - Country:US
Mailing Address - Phone:615-994-1314
Mailing Address - Fax:615-915-1500
Practice Address - Street 1:103 CONTINENTAL PL STE 120
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1086
Practice Address - Country:US
Practice Address - Phone:615-994-1314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5085101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health