Provider Demographics
NPI:1952674640
Name:OWENS, MICHELLE (MED)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:M ED
Mailing Address - Street 1:10001 SOUTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7315
Mailing Address - Country:US
Mailing Address - Phone:405-692-6144
Mailing Address - Fax:
Practice Address - Street 1:10001 SOUTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7315
Practice Address - Country:US
Practice Address - Phone:405-692-6144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst