Healthcare Provider Details

I. General information

NPI: 1528724721
Provider Name (Legal Business Name): KRISTOPHER C LOWRY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 W 26TH ST
JOPLIN MO
64804-0322
US

IV. Provider business mailing address

2510 W 26TH ST
JOPLIN MO
64804-3103
US

V. Phone/Fax

Practice location:
  • Phone: 417-627-9601
  • Fax:
Mailing address:
  • Phone: 405-651-9202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024003429
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: