Healthcare Provider Details

I. General information

NPI: 1841463890
Provider Name (Legal Business Name): MS. SHIRLEY JEANNE OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BOREN BLVD
SEMINOLE OK
74868-2050
US

IV. Provider business mailing address

901 MCGREGOR ST
SEMINOLE OK
74868-4505
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-4507
  • Fax:
Mailing address:
  • Phone: 405-712-3402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: