MEDICARE: JONATHAN OWEN

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	101YM0800X	Mental Health Counselor	ALC06007	AL

General Provider Information

NPI Number	:	1770415382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN OWEN

Provider Business Mailing Address
First Line	:	16A CALHOUN RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36109-2042
Country	:	US
Telephone Number	:	334-462-0977
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 TECHNACENTER DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-6028
Country	:	US
Telephone Number	:	334-462-0977
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ JONATHAN OWEN ” Practice Location

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