Healthcare Provider Details

I. General information

NPI: 1407221161
Provider Name (Legal Business Name): LONNIE OWEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2015
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14930 MUESCHKE RD STE 100
CYPRESS TX
77433-0980
US

IV. Provider business mailing address

5850 LYNBROOK DR
HOUSTON TX
77057-2250
US

V. Phone/Fax

Practice location:
  • Phone: 346-206-3992
  • Fax: 832-652-3626
Mailing address:
  • Phone: 614-306-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number67783
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11475
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: