Doctor Name: | MR. CAMRON TYLER OWENS |
NPI Number: | 1093090227 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 801 E Main St Tishomingo, OK - 734602351 |
Business Phone Number: | 5803713799 |
Business Fax Number: | 5803712056 |
Mailing Address: | 1307 S Johnston St, ADA |
State: | OK |
Postal Code: | 748208149 |
Phone Number: | 5804216980 |
Fax Number: | |
NPI Enumeration Date: | 10/19/2011 |
NPI Last Update Date: | 10/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |