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General NPI Number Information
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NPI Number | 1306722293
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Entity Type | Individual
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Provider Name | SHAUN DOUGLAS LOWERY LLMSW, MDIV
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Gender | Male
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 2333 BIDDLE AVE
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City | WYANDOTTE
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State | MI
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Zip | 48192-4668
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Country | US
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Telephone | 734-287-1382
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Fax | 734-418-3911
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Provider Business Mailing Address
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Address Line | 15862 GOLFVIEW DR UNIT 132
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City | RIVERVIEW
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State | MI
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Zip | 48193-8089
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Country | US
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Telephone | 734-559-6510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851119543
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License Number State | MI
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