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General NPI Number Information
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NPI Number | 1144452095
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Entity Type | Individual
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Provider Name | KELLI A. OWEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/11/2009
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 31625 HIGHWAY 101 S
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City | SOLEDAD
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State | CA
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Zip | 93960-9529
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Country | US
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Telephone | 831-678-5500
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Fax |
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Provider Business Mailing Address
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Address Line | 2525 ASHLAND ST
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City | ASHLAND
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State | OR
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Zip | 97520-1411
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Country | US
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Telephone | 916-367-9888
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | X-07318
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW87331
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License Number State | CA
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