1811092422 NPI number — MS. GEORGANN E OWENS LMSW-LCSW

Table of content: MS. GEORGANN E OWENS LMSW-LCSW (NPI 1811092422)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811092422 NPI number — MS. GEORGANN E OWENS LMSW-LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWENS
Provider First Name:
GEORGANN
Provider Middle Name:
E
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW-LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811092422
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78270-0567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-224-0602
Provider Business Mailing Address Fax Number:
210-226-7153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
343 W HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78205-2107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-224-0602
Provider Business Practice Location Address Fax Number:
210-226-7153
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  26791 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108116802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 257865 . This is a "COMPSYCH PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0039EX . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 348327000 . This is a "MAGELLAN ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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