Active NPI
Mickey Owen, LCSW
- Clinical Social Worker
- Saint Louis, MO
National Provider Identifier
1376929786
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 003410
- Practice address
- 10010 Kennerly Rd
Saint Louis, MO 63128-2106 - Phone
- (314) 525-7236
- Fax
- (314) 525-1886
- NPI assigned
- Aug 7, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 003410 | MO | Primary |
Addresses
Primary practice location
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Mailing address
10010 Kennerly Rd
Saint Louis, MO 63128-2106
Phone (314) 525-7236
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003410 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489536000000",
"number": "1376929786",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10010 KENNERLY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282106",
"telephone_number": "314-525-7236",
"fax_number": "314-525-1886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10010 KENNERLY RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631282106",
"telephone_number": "314-525-7236",
"fax_number": "314-525-1886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OWEN",
"first_name": "MICKEY",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-08-07",
"last_updated": "2017-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "003410",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.