Provider Demographics
NPI:1891558169
Name:OWENS, TINA (PLADC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:PLADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11207 W DODGE RD STE 250
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2650
Mailing Address - Country:US
Mailing Address - Phone:402-612-6328
Mailing Address - Fax:531-213-2377
Practice Address - Street 1:11207 W DODGE RD STE 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2650
Practice Address - Country:US
Practice Address - Phone:402-614-4440
Practice Address - Fax:531-213-2377
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-2138101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)