Individual
BRENDA L OWEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAC, LICSW
Contact information
Practice address
1500 14TH ST W STE 290, WILLISTON, ND 58801-4078
(701) 334-6242
(701) 713-3299
Mailing address
1500 14TH ST W STE 290, WILLISTON, ND 58801-4078
(701) 334-6242
(701) 713-3299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1613
ND
1041C0700X
Clinical Social Worker
Primary
4755
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454696
—
ND
Enumeration date
11/17/2010
Last updated
02/27/2018
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