Healthcare Provider Details

I. General information

NPI: 1861292286
Provider Name (Legal Business Name): KRISTINE OWNBEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 04/13/2025
Certification Date: 04/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987 UNIVERSITY AVE STE 20
LOS GATOS CA
95032-7640
US

IV. Provider business mailing address

PO BOX 1901
CUPERTINO CA
95015-1901
US

V. Phone/Fax

Practice location:
  • Phone: 844-802-6512
  • Fax:
Mailing address:
  • Phone: 844-802-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18110
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: