MEDICARE: MICHAEL CARMON OWENS MA, LPC, LMFT

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	16147	TX
2	106H00000X	Marriage & Family Therapist	4910	TX

General Provider Information

NPI Number	:	1912216318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CARMON OWENS MA, LPC, LMFT

Provider Business Mailing Address
First Line	:	7100 REGENCY SQUARE BLVD STE 136
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3181
Country	:	US
Telephone Number	:	713-780-2833
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 REGENCY SQUARE BLVD STE 136
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77036-3181
Country	:	US
Telephone Number	:	713-780-2833
Fax Number	:

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

Provider Enumeration Date	:	10/02/2010
Last Update Date	:	10/02/2010

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