Provider Demographics
NPI:1447915848
Name:OWENS, DENISE MECHELLE (ASSOCIATE MFT)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MECHELLE
Last Name:OWENS
Suffix:
Gender:F
Credentials:ASSOCIATE MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EL CAMINO REAL STE 213
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3656
Mailing Address - Country:US
Mailing Address - Phone:714-694-3887
Mailing Address - Fax:
Practice Address - Street 1:250 EL CAMINO REAL STE 213
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3656
Practice Address - Country:US
Practice Address - Phone:714-694-3887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119087106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist