Provider Demographics
NPI:1760910285
Name:OWENS, ARCHANDRIA COLETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANDRIA
Middle Name:COLETTE
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 1:1715 STONECREST TRL
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7758
Mailing Address - Country:US
Mailing Address - Phone:901-651-7557
Mailing Address - Fax:
Practice Address - Street 1:1340 PRUDENTIAL DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-4115
Practice Address - Country:US
Practice Address - Phone:901-651-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-28
Last Update Date:2017-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X, 103TC1900X
TX37505103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling