Provider Demographics
NPI:1841463890
Name:OWENS, SHIRLEY JEANNE
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEANNE
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MCGREGOR ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-4505
Mailing Address - Country:US
Mailing Address - Phone:405-712-3402
Mailing Address - Fax:
Practice Address - Street 1:2010 BOREN BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-2050
Practice Address - Country:US
Practice Address - Phone:405-382-4507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health