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General NPI Number Information
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NPI Number | 1588229678
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Entity Type | Individual
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Provider Name | ANTONIO OWENS
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Gender | Male
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Dates
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Enumeration Date | 05/05/2019
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 424 S 47TH WEST AVE
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City | TULSA
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State | OK
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Zip | 74127-7607
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Country | US
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Telephone | 918-991-4825
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Fax |
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Provider Business Mailing Address
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Address Line | 424 S 47TH WEST AVE
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City | TULSA
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State | OK
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Zip | 74127-7607
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Country | US
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Telephone | 918-991-4825
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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 | 374K00000X
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Taxonomy Name | Religious Nonmedical Practitioner
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License Number | 70453
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 10495
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License Number State | OK
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