Provider Demographics
NPI:1942973391
Name:OWEN, KATHRYN (LMHC-A)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 RIVERLANE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE STATION
Mailing Address - State:IN
Mailing Address - Zip Code:46405-1945
Mailing Address - Country:US
Mailing Address - Phone:219-973-5815
Mailing Address - Fax:
Practice Address - Street 1:900 RIDGE RD STE T
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1727
Practice Address - Country:US
Practice Address - Phone:219-213-6009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002552A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health