Provider Demographics
NPI:1780354951
Name:OWEN, CARLEY ELISE (PHD)
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:ELISE
Last Name:OWEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 PRINCE ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-9398
Mailing Address - Country:US
Mailing Address - Phone:501-932-0255
Mailing Address - Fax:501-932-0258
Practice Address - Street 1:4206 PRINCE ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-9398
Practice Address - Country:US
Practice Address - Phone:501-932-0255
Practice Address - Fax:501-932-0258
Is Sole Proprietor?:No
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR202184103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent