Provider Demographics
NPI:1649549882
Name:OWENS, CRYSTAL D (MED)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:D
Last Name:OWENS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HIGH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1006
Mailing Address - Country:US
Mailing Address - Phone:413-495-1500
Mailing Address - Fax:413-747-1811
Practice Address - Street 1:140 HIGH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01199-1006
Practice Address - Country:US
Practice Address - Phone:413-495-1500
Practice Address - Fax:413-747-1811
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1022610OtherBEACON
MA997303OtherNETWORK
MA1134107113OtherMPHP
MA8443OtherBMC