Provider Demographics
NPI:1720002009
Name:OWEN, JO ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:ANN
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W HADLEY WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-4161
Mailing Address - Country:US
Mailing Address - Phone:317-831-4067
Mailing Address - Fax:317-781-0465
Practice Address - Street 1:5218 S. EAST ST.
Practice Address - Street 2:E-4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:317-781-0447
Practice Address - Fax:317-781-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39000348A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional