Healthcare Provider Details

I. General information

NPI: 1295660058
Provider Name (Legal Business Name): MARY CATHERINE OWEN P-LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2668 45TH ST
MERIDIAN MS
39305-2603
US

IV. Provider business mailing address

2668 45TH ST
MERIDIAN MS
39305-2603
US

V. Phone/Fax

Practice location:
  • Phone: 601-917-4435
  • Fax:
Mailing address:
  • Phone: 601-917-4435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-1577
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: