Individual
CHRISTOPHER KYLE OWEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3005 BOARDWALK ST STE 201, ANN ARBOR, MI 48108-5218
(734) 222-9277
Mailing address
3164 ANN ARBOR SALINE RD APT 204, ANN ARBOR, MI 48103-9858
(484) 356-8535
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
6352000733
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6352000733
DOCTORAL TEMPORARY EDUCATIONAL LIMITED LICENSE - PSYCHOLOGIST (TLLP)
MI
Enumeration date
09/22/2022
Last updated
09/22/2022
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