Provider Demographics
NPI:1487971180
Name:OWENS, KEVIN RICHARD (MA)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RICHARD
Last Name:OWENS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 W HENDERSON ST
Mailing Address - Street 2:#2 SIDE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6872
Mailing Address - Country:US
Mailing Address - Phone:510-417-5461
Mailing Address - Fax:
Practice Address - Street 1:1519 W HENDERSON ST
Practice Address - Street 2:#2 SIDE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6872
Practice Address - Country:US
Practice Address - Phone:510-417-5461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health