Provider Demographics
NPI:1619000890
Name:OWENS, CASSANDRA RELYNN (LAC)
Entity type:Individual
Prefix:MS
First Name:CASSANDRA
Middle Name:RELYNN
Last Name:OWENS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:MC NEIL
Mailing Address - State:AR
Mailing Address - Zip Code:71752-0034
Mailing Address - Country:US
Mailing Address - Phone:870-695-3893
Mailing Address - Fax:
Practice Address - Street 1:824 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:AR
Practice Address - Zip Code:71753-3316
Practice Address - Country:US
Practice Address - Phone:870-234-0495
Practice Address - Fax:870-234-9481
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0311095101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor