Provider Demographics
NPI:1346129244
Name:OWEN, TREVOR
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:OWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 MARY AVE
Mailing Address - Street 2:
Mailing Address - City:BENTON CITY
Mailing Address - State:WA
Mailing Address - Zip Code:99320-4402
Mailing Address - Country:US
Mailing Address - Phone:503-910-4909
Mailing Address - Fax:
Practice Address - Street 1:3867 WOLVERINE ST NE BLDG F
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4266
Practice Address - Country:US
Practice Address - Phone:503-361-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health