Provider Demographics
NPI:1942767769
Name:OWENS, BRENDAN THOMAS (LMFT)
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:THOMAS
Last Name:OWENS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 LAUREL LEDGE LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4046
Mailing Address - Country:US
Mailing Address - Phone:512-417-5097
Mailing Address - Fax:
Practice Address - Street 1:13706 RESEARCH BLVD STE 114
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1838
Practice Address - Country:US
Practice Address - Phone:512-417-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist