Healthcare Provider Details

I. General information

NPI: 1720002009
Provider Name (Legal Business Name): JO ANN OWEN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 S. EAST ST. E-4
INDIANAPOLIS IN
46227
US

IV. Provider business mailing address

16 W HADLEY WOODLAND ST
MOORESVILLE IN
46158-4161
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-0447
  • Fax: 317-781-0465
Mailing address:
  • Phone: 317-831-4067
  • Fax: 317-781-0465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number39000348A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: