Provider Demographics
NPI:1770643421
Name:OWEN, JO A (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:A
Last Name:OWEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2959 MERAMAR DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-5636
Mailing Address - Country:US
Mailing Address - Phone:314-846-7730
Mailing Address - Fax:636-464-1215
Practice Address - Street 1:3608 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3920
Practice Address - Country:US
Practice Address - Phone:636-464-1915
Practice Address - Fax:636-464-1215
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health