Provider Demographics
NPI:1013063130
Name:OWENS, MIRIAM (LPC)
Entity type:Individual
Prefix:MS
First Name:MIRIAM
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 SANDERSON AVENUE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80915
Mailing Address - Country:US
Mailing Address - Phone:719-597-0413
Mailing Address - Fax:
Practice Address - Street 1:1611 SANDERSON AVENUE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80915
Practice Address - Country:US
Practice Address - Phone:719-380-7170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
089382OtherVALUE OPTIONS HEALTHCARE