Basic Information
| Provider Information | |||||||||
| NPI: | 1154604049 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | ABBEY | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 HOLIDAY DR | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624011727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178256527 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 N 4TH ST | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624013032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173477179 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2011 | ||||||||
| LastUpdateDate: | 09/27/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 26545 | IL | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.