Healthcare Provider Details

I. General information

NPI: 1104071307
Provider Name (Legal Business Name): MATTHEW C LOWRY LPP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SEARS AVE STE 202
ST MATTHEWS KY
40207-5072
US

IV. Provider business mailing address

108 OLYMPIA DR
BARDSTOWN KY
40004-2111
US

V. Phone/Fax

Practice location:
  • Phone: 502-265-6790
  • Fax:
Mailing address:
  • Phone: 502-286-0556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number168059
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: