Individual
MR. MATTHEW SHANE OWENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
420 W 5TH AVE, FLINT, MI 48503-2445
(248) 678-4749
Mailing address
19705 VINE DR, MACOMB, MI 48044-6518
(248) 678-4749
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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