Provider Demographics
NPI:1881024909
Name:OWENS, SANDRA (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 W SERENE AVE UNIT 245
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-6549
Mailing Address - Country:US
Mailing Address - Phone:702-612-6371
Mailing Address - Fax:
Practice Address - Street 1:1676 RAVANUSA DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3103
Practice Address - Country:US
Practice Address - Phone:702-612-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-27
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9009-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical