Healthcare Provider Details

I. General information

NPI: 1104882182
Provider Name (Legal Business Name): CATHY F OWEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FLETCHER DRIVE STUDENT HEALLTH CARE CENTER
GAINESVILLE FL
32611
US

IV. Provider business mailing address

3647 NW 30TH BLVD
GAINESVILLE FL
32605-2669
US

V. Phone/Fax

Practice location:
  • Phone: 352-392-1171
  • Fax:
Mailing address:
  • Phone: 352-371-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW 211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: