Healthcare Provider Details

I. General information

NPI: 1689454886
Provider Name (Legal Business Name): JASON ALLEN OWENS LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E OCEAN BLVD APT 2503
LONG BEACH CA
90802-5384
US

IV. Provider business mailing address

777 E OCEAN BLVD APT 2503
LONG BEACH CA
90802-5384
US

V. Phone/Fax

Practice location:
  • Phone: 734-377-7222
  • Fax:
Mailing address:
  • Phone: 734-377-7222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: