Provider Demographics
NPI:1760929343
Name:OWENS, JQUAN
Entity Type:Individual
Prefix:
First Name:JQUAN
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 PALATINE HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89081-6540
Mailing Address - Country:US
Mailing Address - Phone:702-587-3723
Mailing Address - Fax:702-333-4480
Practice Address - Street 1:3416 PALATINE HILLS AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-6540
Practice Address - Country:US
Practice Address - Phone:702-587-3723
Practice Address - Fax:702-333-4480
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-20
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health