Healthcare Provider Details

I. General information

NPI: 1407165939
Provider Name (Legal Business Name): MR. LOWELL STANFORD MCGUIRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 10/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY BLDG 8B
SPARKS NV
89431-5564
US

IV. Provider business mailing address

1325 MCDONALD DR
RENO NV
89503-3554
US

V. Phone/Fax

Practice location:
  • Phone: 775-333-0943
  • Fax:
Mailing address:
  • Phone: 775-229-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: