Healthcare Provider Details

I. General information

NPI: 1659280857
Provider Name (Legal Business Name): JENNIFER OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 VILLAGE SQUARE XING STE 103
PALM BEACH GARDENS FL
33410-4548
US

IV. Provider business mailing address

301 RUDDER CAY WAY
JUPITER FL
33458-1636
US

V. Phone/Fax

Practice location:
  • Phone: 561-905-7788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29743
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: