Provider Demographics
NPI:1669870127
Name:OWEN, BRET THOMAS (LPC, MED)
Entity type:Individual
Prefix:MR
First Name:BRET
Middle Name:THOMAS
Last Name:OWEN
Suffix:
Gender:M
Credentials:LPC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 ASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5223
Mailing Address - Country:US
Mailing Address - Phone:419-351-7380
Mailing Address - Fax:
Practice Address - Street 1:701 JEFFERSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-6957
Practice Address - Country:US
Practice Address - Phone:419-321-6455
Practice Address - Fax:419-321-6452
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health