Healthcare Provider Details

I. General information

NPI: 1902010325
Provider Name (Legal Business Name): MEGHAN BRIDGET OWENZ PH.D., ABPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 PASEO REYES DR
SAINT AUGUSTINE FL
32095-8558
US

IV. Provider business mailing address

101 MARKETSIDE AVE SUITE 404, BOX 172
PONTE VEDRA FL
32081
US

V. Phone/Fax

Practice location:
  • Phone: 904-373-8871
  • Fax:
Mailing address:
  • Phone: 904-373-8871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number12447
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: