Provider Demographics
NPI:1144820556
Name:OWENS, REGINALD (CIT)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:
Last Name:OWENS
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-4538
Mailing Address - Country:US
Mailing Address - Phone:985-223-4009
Mailing Address - Fax:985-223-7002
Practice Address - Street 1:214 HIGH ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-4538
Practice Address - Country:US
Practice Address - Phone:985-223-4009
Practice Address - Fax:985-223-7002
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008911403101YA0400X
LACIT-5203101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)