Basic Information
| Provider Information | |||||||||
| NPI: | 1649549882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OWENS | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 140 HIGH ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134951500 | ||||||||
| FaxNumber: | 4137471811 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 HIGH ST | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011991006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4134951500 | ||||||||
| FaxNumber: | 4137471811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2011 | ||||||||
| LastUpdateDate: | 11/04/2016 | ||||||||
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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 | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1022610 | 01 | MA | BEACON | OTHER | 997303 | 01 | MA | NETWORK | OTHER | 1134107113 | 01 | MA | MPHP | OTHER | 8443 | 01 | MA | BMC | OTHER |