Provider Demographics
NPI:1740705821
Name:OWENS, IRIS (BCBA)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3728 REDONDO BEACH BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1229
Mailing Address - Country:US
Mailing Address - Phone:310-245-0978
Mailing Address - Fax:
Practice Address - Street 1:3728 REDONDO BEACH BLVD APT C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1229
Practice Address - Country:US
Practice Address - Phone:310-245-0978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-17224103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
14080069OtherCAQH