Individual
MR. MATTHEW SHANE OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
6361005054
MI
251S00000X
Community/Behavioral Health Agency
Primary
6301011431
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
386004868
FEDERAL TAX ID
MI
Enumeration date
02/28/2007
Last updated
09/09/2021
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