Basic Information
| Provider Information | |||||||||
| NPI: | 1275762452 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRAVIS H. OWENS, PSY.D. INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1891 E ROSEVILLE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956617974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167897082 | ||||||||
| FaxNumber: | 9167978840 | ||||||||
| Practice Location | |||||||||
| Address1: | 1891 E ROSEVILLE PKWY STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956617974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167897082 | ||||||||
| FaxNumber: | 9167978840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2009 | ||||||||
| LastUpdateDate: | 07/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | TRAVIS | ||||||||
| AuthorizedOfficialMiddleName: | HENRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9167897082 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.