Basic Information
| Provider Information | |||||||||
| NPI: | 1871839811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OWEN | ||||||||
| FirstName: | KEATON | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 225 CROSSROADS BLVD # 275 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939238674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8312772733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 343 DELA VINA AVE | ||||||||
| Address2: | |||||||||
| City: | MONTEREY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939403974 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316473000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2012 | ||||||||
| LastUpdateDate: | 12/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.