Provider Demographics
NPI:1952815219
Name:OWEN, JESSICA LEIGH (LMFT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 BEECH GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-5537
Mailing Address - Country:US
Mailing Address - Phone:423-235-9416
Mailing Address - Fax:
Practice Address - Street 1:441 CLAY ST STE 2
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3693
Practice Address - Country:US
Practice Address - Phone:423-247-4536
Practice Address - Fax:423-247-1117
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-24
Last Update Date:2017-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist