MEDICARE: DR. BEVERLY JEAN OWEN ED.D.

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	101YM0800X	Mental Health Counselor	00964	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417968322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEVERLY JEAN OWEN ED.D.

Provider Business Mailing Address
First Line	:	6565 N MACARTHUR BLVD
Second Line	:	SUITE 225
City	:	IRVING
State	:	TX
Zip	:	75039-2461
Country	:	US
Telephone Number	:	972-759-7118
Fax Number	:

Provider Business Practice Location Address
First Line	:	6565 N MACARTHUR BLVD
Second Line	:	SUITE 225
City	:	IRVING
State	:	TX
Zip	:	75039-2461
Country	:	US
Telephone Number	:	972-759-7118
Fax Number	:

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

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	07/09/2007

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