Provider Demographics
NPI:1720349079
Name:OWENS, MICHELE DENISE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:DENISE
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93305-2937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:661-903-4885
Practice Address - Street 1:3535 UNION AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93305-2937
Practice Address - Country:US
Practice Address - Phone:661-903-4885
Practice Address - Fax:661-903-4885
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARW5640101YA0400X
CA14325101YM0800X
390200000X
CA40844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program