Provider Demographics
NPI:1487296422
Name:OWEN, CAROL JEAN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JEAN
Last Name:OWEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:COCO
Other - Middle Name:
Other - Last Name:OWEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17254 QUESAN PL
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3934
Mailing Address - Country:US
Mailing Address - Phone:310-666-9730
Mailing Address - Fax:
Practice Address - Street 1:17254 QUESAN PL
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3934
Practice Address - Country:US
Practice Address - Phone:818-740-4666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-10
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31325103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging