Provider Demographics
NPI:1174586325
Name:DANIEL OWENS PH.D. P.C.
Entity type:Organization
Organization Name:DANIEL OWENS PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-845-4454
Mailing Address - Street 1:210 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2618
Mailing Address - Country:US
Mailing Address - Phone:434-845-4454
Mailing Address - Fax:434-845-4299
Practice Address - Street 1:210 ROWLAND DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2618
Practice Address - Country:US
Practice Address - Phone:434-845-4454
Practice Address - Fax:434-845-4299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA182047OtherANTHEM PROVIDER ID #
VAC09700Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
VA182047OtherANTHEM PROVIDER ID #