Basic Information
| Provider Information | |||||||||
| NPI: | 1861516411 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5154 STAGE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729133 | ||||||||
| FaxNumber: | 9013721015 | ||||||||
| Practice Location | |||||||||
| Address1: | 5154 STAGE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381343118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013729133 | ||||||||
| FaxNumber: | 9013721015 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 2184 | TN | Y | Behavioral Health & Social Service Providers | Psychologist |
ID Information
| ID | Type | State | Issuer | Description | 2134262 | 01 | TN | CIGNA PROVIDER # | OTHER |