MEDICARE: MS. MIRIAM OWENS LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	365	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	089382	OTHER		VALUE OPTIONS HEALTHCARE

General Provider Information

NPI Number	:	1013063130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRIAM OWENS LPC

Provider Business Mailing Address
First Line	:	1611 SANDERSON AVENUE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915
Country	:	US
Telephone Number	:	719-597-0413
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 SANDERSON AVENUE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80915
Country	:	US
Telephone Number	:	719-380-7170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/08/2007

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