Provider Demographics
NPI:1669233805
Name:THE OWEN ACADEMY, LLC
Entity type:Organization
Organization Name:THE OWEN ACADEMY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EDO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNA
Authorized Official - Middle Name:THORNTON
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-706-6936
Mailing Address - Street 1:107 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-4700
Mailing Address - Country:US
Mailing Address - Phone:580-706-6936
Mailing Address - Fax:
Practice Address - Street 1:107 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-4700
Practice Address - Country:US
Practice Address - Phone:580-706-6936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty