Healthcare Provider Details

I. General information

NPI: 1356684856
Provider Name (Legal Business Name): JOELLEEN A LOWE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1949 SNOWBERRY LN
JOPLIN MO
64804-5420
US

IV. Provider business mailing address

PO BOX 2526
JOPLIN MO
64803-2526
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-7850
  • Fax: 417-347-7608
Mailing address:
  • Phone: 417-347-7600
  • Fax: 417-347-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2013008642
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: