Provider Demographics
NPI:1851171268
Name:OWENS, ETHAN (MA)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 2ND ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3361
Mailing Address - Country:US
Mailing Address - Phone:727-490-9911
Mailing Address - Fax:
Practice Address - Street 1:146 2ND ST N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3361
Practice Address - Country:US
Practice Address - Phone:727-490-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)