MEDICARE: DR. ARCHANDRIA COLETTE OWENS PH.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	103TP2701X	Group Psychotherapy Psychologist
2	103TC1900X	Counseling Psychologist
3	103T00000X	Psychologist	37505	TX

General Provider Information

NPI Number	:	1760910285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARCHANDRIA COLETTE OWENS PH.D.

Provider Business Mailing Address
First Line	:	1715 STONECREST TRL
Second Line	:
City	:	WYLIE
State	:	TX
Zip	:	75098-7758
Country	:	US
Telephone Number	:	901-651-7557
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 PRUDENTIAL DR
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75235-4115
Country	:	US
Telephone Number	:	901-651-7557
Fax Number	:

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

Provider Enumeration Date	:	05/28/2017
Last Update Date	:	05/28/2017

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