Healthcare Provider Details

I. General information

NPI: 1184737025
Provider Name (Legal Business Name): FRANCES KAY OWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 FIRST STREET SOUTH
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

200 AVE F NE
WINTER HAVEN FL
33880
US

V. Phone/Fax

Practice location:
  • Phone: 863-293-1121
  • Fax:
Mailing address:
  • Phone: 863-293-1121
  • Fax: 863-291-6084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH3531
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: