Basic Information
| Provider Information | |||||||||
| NPI: | 1619006459 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWEN-WILSON | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | OWEN | ||||||||
| OtherFirstName: | MARGARET | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3301 E. 12TH STREET, SUITE 259 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106983919 | ||||||||
| FaxNumber: | 5102699031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3301 E 12TH ST STE 259 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108693919 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 09/09/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC2200X | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.