Provider Demographics
NPI:1669295572
Name:OWENS, CANDICE LUTHER (RBT)
Entity type:Individual
Prefix:
First Name:CANDICE
Middle Name:LUTHER
Last Name:OWENS
Suffix:
Gender:U
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 CHURCH ST UNIT 330418
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3075
Mailing Address - Country:US
Mailing Address - Phone:615-521-7412
Mailing Address - Fax:
Practice Address - Street 1:401 S MOUNT JULIET RD STE 235-118
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-6359
Practice Address - Country:US
Practice Address - Phone:877-504-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-23-317841106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician