Healthcare Provider Details

I. General information

NPI: 1194547190
Provider Name (Legal Business Name): PARENT PSYCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
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 STE 404
PONTE VEDRA FL
32081-1542
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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGHAN OWENZ
Title or Position: LICENSED PSYCHOLOGIST
Credential: PH.D., ABPP
Phone: 904-373-8871