Provider Demographics
NPI:1811092422
Name:OWENS, GEORGANN E (LMSW-LCSW)
Entity type:Individual
Prefix:MS
First Name:GEORGANN
Middle Name:E
Last Name:OWENS
Suffix:
Gender:F
Credentials:LMSW-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700567
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78270-0567
Mailing Address - Country:US
Mailing Address - Phone:210-224-0602
Mailing Address - Fax:210-226-7153
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-224-0602
Practice Address - Fax:210-226-7153
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX267911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108116802Medicaid
TX257865OtherCOMPSYCH PROVIDER #
TX0039EXOtherBLUECROSS BLUESHIELD
TX348327000OtherMAGELLAN ID
TX00982EMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER