Provider Demographics
NPI:1265564108
Name:OWENS, ERICA MARTHA KEUS
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:MARTHA KEUS
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230318
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0318
Mailing Address - Country:US
Mailing Address - Phone:760-803-5912
Mailing Address - Fax:
Practice Address - Street 1:119 ABERDEEN DR STE 6
Practice Address - Street 2:
Practice Address - City:CARDIFF
Practice Address - State:CA
Practice Address - Zip Code:92007-1841
Practice Address - Country:US
Practice Address - Phone:760-803-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist