Provider Demographics
NPI:1043679806
Name:OWENS, KRISTINE ELLEN (MA, BCBA)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:ELLEN
Last Name:OWENS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 BAYFLOWER WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32836-3760
Mailing Address - Country:US
Mailing Address - Phone:321-217-7778
Mailing Address - Fax:
Practice Address - Street 1:7930 BAYFLOWER WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32836-3760
Practice Address - Country:US
Practice Address - Phone:321-217-7778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-15-20861103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst