Healthcare Provider Details

I. General information

NPI: 1467823286
Provider Name (Legal Business Name): ROBIN OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 LINE AVE STE 315
SHREVEPORT LA
71101
US

IV. Provider business mailing address

9245 WALLACE LAKE RD STE A
SHREVEPORT LA
71106-7331
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-2828
  • Fax:
Mailing address:
  • Phone: 318-221-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: