Healthcare Provider Details

I. General information

NPI: 1346227550
Provider Name (Legal Business Name): MALINDA GANN LOWERY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALINDA S GANN

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 W US HIGHWAY 40
ODESSA MO
64076-9612
US

IV. Provider business mailing address

1800 COMMUNITY
CLINTON MO
64735-8804
US

V. Phone/Fax

Practice location:
  • Phone: 844-853-8937
  • Fax:
Mailing address:
  • Phone: 844-853-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2002026261
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2002026261
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: