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General NPI Number Information
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NPI Number | 1558998419
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Entity Type | Individual
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Provider Name | THOMAS EDWARD OWENS III BA, CGCS, ICADC, SAP
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Gender | Male
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Dates
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Enumeration Date | 03/23/2020
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 706 ALSTON ST
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City | OZARK
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State | AR
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Zip | 72949-9789
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Country | US
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Telephone | 479-209-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 706 ALSTON ST
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City | OZARK
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State | AR
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Zip | 72949-9789
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Country | US
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Telephone | 479-209-0661
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 174114
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 2130
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 829792
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License Number State | AR
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SAP174114
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License Number State | AR
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Taxonomy #5
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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