Basic Information
| Provider Information | |||||||||
| NPI: | 1417331877 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | BOBBI | ||||||||
| MiddleName: | JO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6199 MILLER RD | ||||||||
| Address2: | STE A | ||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484731585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105138264 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Practice Location | |||||||||
| Address1: | 6199 MILLER RD | ||||||||
| Address2: | STE A | ||||||||
| City: | SWARTZ CREEK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484731585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8105138264 | ||||||||
| FaxNumber: | 5173239531 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2015 | ||||||||
| LastUpdateDate: | 07/16/2015 | ||||||||
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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 | 101YP2500X | 6401011684 | MI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.