MEDICARE: CARLEY ELISE OWEN PH.D.

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	103TC2200X	Clinical Child & Adolescent Psychologist	202184	AR

General Provider Information

NPI Number	:	1780354951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLEY ELISE OWEN PH.D.

Provider Business Mailing Address
First Line	:	4206 PRINCE ST
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-9398
Country	:	US
Telephone Number	:	501-932-0255
Fax Number	:	501-932-0258

Provider Business Practice Location Address
First Line	:	4206 PRINCE ST
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72034-9398
Country	:	US
Telephone Number	:	501-932-0255
Fax Number	:	501-932-0258

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

Provider Enumeration Date	:	09/17/2021
Last Update Date	:	09/11/2025

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