Healthcare Provider Details

I. General information

NPI: 1366420796
Provider Name (Legal Business Name): TENEA M LOWMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TENEA M. RUSSELL PSYD

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N. MAIN
WINDSOR MO
65360
US

IV. Provider business mailing address

613 S STATE FAIR BLVD
SEDALIA MO
65301-2415
US

V. Phone/Fax

Practice location:
  • Phone: 660-647-2182
  • Fax: 660-647-2217
Mailing address:
  • Phone: 660-647-2182
  • Fax: 660-647-2217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2006029885
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: