Provider Demographics
NPI:1255196101
Name:OWEN, CHARLIE WESLEY
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:WESLEY
Last Name:OWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 GREEN ACRES RD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-1791
Mailing Address - Country:US
Mailing Address - Phone:541-762-4500
Mailing Address - Fax:
Practice Address - Street 1:1420 GREEN ACRES RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1791
Practice Address - Country:US
Practice Address - Phone:541-762-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
T-23-3262101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)