Provider Demographics
NPI:1811510688
Name:OWENS, STACEY DENISE (HYPNOTHERAPIST)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:DENISE
Last Name:OWENS
Suffix:
Gender:F
Credentials:HYPNOTHERAPIST
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 1073
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1073
Mailing Address - Country:US
Mailing Address - Phone:606-253-0682
Mailing Address - Fax:
Practice Address - Street 1:112 KENTUCKY AVE APT 5
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-9129
Practice Address - Country:US
Practice Address - Phone:606-422-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst