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General NPI Number Information
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NPI Number | 1194547190
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Entity Type | Organization
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Legal Business Name | PARENT PSYCH LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 416 PASEO REYES DR
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32095-8558
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Country | US
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Telephone | 904-373-8871
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Fax |
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Provider Business Mailing Address
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Address Line | 101 MARKETSIDE AVE STE 404
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City | PONTE VEDRA
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State | FL
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Zip | 32081-1542
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Country | US
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Telephone | 904-373-8871
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | DR. MEGHAN OWENZ
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Credential | PH.D., ABPP
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Telephone | 904-373-8871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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