Healthcare Provider Details

I. General information

NPI: 1114658549
Provider Name (Legal Business Name): OWEN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2022
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 E BRITTON RD STE B
JONES OK
73049-7407
US

IV. Provider business mailing address

12901 E BRITTON RD STE B
JONES OK
73049-7407
US

V. Phone/Fax

Practice location:
  • Phone: 405-740-1249
  • Fax: 405-399-2471
Mailing address:
  • Phone: 405-740-1249
  • Fax: 405-399-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVON OWEN
Title or Position: CLINICAL DIRECTOR, CLINICIAN
Credential: DCOUN
Phone: 405-740-1249