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General NPI Number Information
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NPI Number | 1083245930
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Entity Type | Individual
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Provider Name | SHIELA LAVERNE OWENS
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Gender | Female
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Dates
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Enumeration Date | 01/29/2020
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Last Update Date | 01/29/2020
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Provider Practice Location Address
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Address Line | 2137 FOX HOLLOW DR
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City | OKEMOS
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State | MI
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Zip | 48864-3922
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Country | US
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Telephone | 517-712-3903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 305
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City | EAST LANSING
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State | MI
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Zip | 48826-0305
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Country | US
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Telephone | 517-712-3903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401016872
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License Number State | MI
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