MEDICARE: DR. DARYA OWENS

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	103TB0200X	Cognitive & Behavioral Psychologist		MI
2	247200000X	Other Technician

General Provider Information

NPI Number	:	1548654148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARYA OWENS

Provider Business Mailing Address
First Line	:	1235 SAINT CLAIR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3671
Country	:	US
Telephone Number	:	313-402-9303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1235 SAINT CLAIR ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-3671
Country	:	US
Telephone Number	:	313-402-9303
Fax Number	:

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

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	10/22/2018

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