Provider Demographics
NPI:1891261202
Name:OWENS, TOSHA MONYETTE (MA)
Entity Type:Individual
Prefix:
First Name:TOSHA
Middle Name:MONYETTE
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TOSHA
Other - Middle Name:M
Other - Last Name:OWENS-ERVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:313 LENNON LN STE 100
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2460
Mailing Address - Country:US
Mailing Address - Phone:925-289-1090
Mailing Address - Fax:
Practice Address - Street 1:2085 RUSTIN AVE STE 5
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2498
Practice Address - Country:US
Practice Address - Phone:951-509-2400
Practice Address - Fax:951-509-2404
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2023-09-11
Deactivation Date:2023-07-30
Deactivation Code:
Reactivation Date:2023-09-11
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA7607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician