MEDICARE: DR. BRENDA EARL OWENSBY PHD

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	103TC0700X	Clinical Psychologist	1276	TN
2	103TC1900X	Counseling Psychologist	1276	TN

General Provider Information

NPI Number	:	1548520745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENDA EARL OWENSBY PHD

Provider Business Mailing Address
First Line	:	12201 E DONCASTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37932-2844
Country	:	US
Telephone Number	:	865-405-2704
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 STEKOIA LN
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-1608
Country	:	US
Telephone Number	:	865-296-2070
Fax Number	:

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

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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