MALLORY OWENS (NPI# 1174972855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174972855 |
| Entity Type | Individual |
| Full Name | MALLORY OWENS |
| Credential | MSW |
| Practice Address |
904 M L King Dr Centralia IL 62801-3058 |
| Practice Telephone | 6185331391 |
| Practice Fax Number | 6185330012 |
| Mailing Telephone | 6185331391 |
| Mailing Fax Number | 6185330012 |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101Y00000X | Counselor | Behavioral Health & Social Service Providers | ||
| N | 101YM0800X |
Counselor Specialization: Mental Health |
Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 370915481007 | 05 |
| Street Address |
904 M L KING DR |
| City | CENTRALIA |
| State | IL |
| Zip Code | 62801-3058 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447222419 | Janet Rose Merrell | Nurse Practitioner | 904 M L King Dr, Centralia, IL 62801-3532 | 2006-02-03 |
| 1649748039 | Laurie Foster | Counselor | 904 M L King Dr, Centralia, IL 62801-3532 | 2018-11-05 |
| 1215455126 | Maria Gabriela Dulle | Counselor | 904 M L King Dr, Centralia, IL 62801-3058 | 2017-08-31 |
| 1427418573 | Destiny Norman | Counselor | 904 M L King Dr, Centralia, IL 62801-3058 | 2016-03-02 |
| 1114350311 | Carlie Michelle Kasten | Counselor | 904 M L King Dr, Centralia, IL 62801-3058 | 2013-08-12 |
| 1487087680 | Lisa Marie Russow | Counselor | 904 M L King Dr, Centralia, IL 62801-3058 | 2013-08-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1629573365 | Prabhat Shrestha | Student in an Organized Health Care Education/Training Program | 605 Sable Drive, Centralia, IL 62801 | 2018-03-26 |
| 1619496098 | Whitney Rathmann | Speech-Language Pathologist | 224 South Locust, Centralia, IL 62801 | 2017-09-17 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| 1568820637 | Midland Area Agency On Aging | Case Management | 434 S Poplar Street, Centralia, IL 62801 | 2016-02-04 |
| 1104201714 | Keri Douglas | Nurse Practitioner | 1054 M. L. King Drive #125, Centrailia, IL 62801 | 2015-07-24 |
| 1215331509 | Melissa Dane | Counselor | 904 E Martin Luther King Dr., Centralia, IL 62801 | 2014-10-15 |
| Find all providers in zip 62801 | ||||
| Taxonomy Code | 101Y00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master’s degree and clinical experience and supervision for licensure or certification. |
| Notes: Sources: Abridged from definitions provided by the National Board of Certified Counselors and the American Association of Pastoral Counselors. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385821 | Joshua Bigner | Counselor | 201 S Tower Ave Apt E2, Centralia, WA 98531-4055 | 2020-10-28 |
| 1356996151 | Matthew Crawford | Counselor | 904 E Martin Luther King Dr, Centralia, IL 62801 | 2019-08-08 |
| 1588130314 | Kennah White | Counselor | 904 E. Mlk Drive, Centralia, IL 62801 | 2018-10-19 |
| 1245721588 | Lindsey Nicole Fogliasso | Counselor | 904 East Mlk Dr., Centralia, IL 62801 | 2018-05-22 |
| 1376078246 | Ashley Patrice Broussard | Counselor | 1723 Kresky Ave, Centralia, WA 98531-8985 | 2017-04-27 |
| 1376082685 | Athena A Smith | Counselor | 904 E. Martin Luther King Dr, Centralia, IL 62801 | 2017-02-20 |
| 1023552551 | Kelsey Dulle | Counselor | 904 Martin Luther King Drive, Centralia, IL 62801-3058 | 2016-12-19 |
| 1548703580 | Tiana Barbee | Counselor | 904 Mlk Drive, Centralia, IL 62801-3058 | 2016-11-23 |
| 1518411131 | Shelia Wilson | Counselor | 904 E. Martin Luther King, Centralia, IL 62801-3058 | 2016-08-11 |
| 1447704069 | Meghan Branch | Counselor | 904 Martin Luther King Dr, Centralia, IL 62801 | 2016-08-11 |
| Find all providers in CENTRALIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.