Provider Demographics
NPI:1659305258
Name:OWEN, CYNTHIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:OWEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 VILLAGE SQUARE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9060
Mailing Address - Country:US
Mailing Address - Phone:270-538-0851
Mailing Address - Fax:270-538-0852
Practice Address - Street 1:5120 VILLAGE SQUARE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9060
Practice Address - Country:US
Practice Address - Phone:270-538-0851
Practice Address - Fax:270-538-0852
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY556419000OtherMAGELLAN ID
KY682871OtherHEALTHLINK ID
KY262679OtherCOMPSYCH ID
KY000000297380OtherBCBS ID
KY262679OtherCOMPSYCH ID