Provider Demographics
NPI:1831204064
Name:OWEN, BRADFORD HANEY (LPA)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:HANEY
Last Name:OWEN
Suffix:
Gender:M
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 FLEMING ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:828-693-9560
Practice Address - Street 1:257 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4158
Practice Address - Country:US
Practice Address - Phone:828-258-2597
Practice Address - Fax:828-285-9679
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1376103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046FROtherNVML BCBS GRP # 015HF
NC6107039Medicaid