Healthcare Provider Details

I. General information

NPI: 1245501022
Provider Name (Legal Business Name): TERRY L OWENS MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 W BROADWAY ST
HOLLIS OK
73550-4202
US

IV. Provider business mailing address

222 E SHERIDAN AVE STE 2
OKLAHOMA CITY OK
73104-4209
US

V. Phone/Fax

Practice location:
  • Phone: 580-688-9281
  • Fax: 580-688-2669
Mailing address:
  • Phone: 405-200-0131
  • Fax: 405-270-0543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: