Healthcare Provider Details

I. General information

NPI: 1396864419
Provider Name (Legal Business Name): SARA RUTH OWENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 OLD PECOS TRL
SANTA FE NM
87505-4779
US

IV. Provider business mailing address

PO BOX 22846
SANTA FE NM
87502-2846
US

V. Phone/Fax

Practice location:
  • Phone: 505-660-8240
  • Fax:
Mailing address:
  • Phone: 505-660-8240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0800
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: