MEDICARE: PHILLIP OWENS ED.D., LPC/MHSP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11720	TN
2	101YP2500X	Professional Counselor	1804	TN

General Provider Information

NPI Number	:	1710230628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP OWENS ED.D., LPC/MHSP

Provider Business Mailing Address
First Line	:	1000 JEFFERSON ST STE 2C
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24504-1724
Country	:	US
Telephone Number	:	540-217-6461
Fax Number	:	615-814-2924

Provider Business Practice Location Address
First Line	:	4004 HILLSBORO RD STE A207
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2228
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/20/2021

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