MEDICARE: MADISON MARIE LOWRIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	82956	TX

General Provider Information

NPI Number	:	1023687266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON MARIE LOWRIE

Provider Business Mailing Address
First Line	:	3200 SANGUINET ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5355
Country	:	US
Telephone Number	:	817-255-2652
Fax Number	:	817-255-2657

Provider Business Practice Location Address
First Line	:	601 W SANFORD ST STE 202
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76011-7086
Country	:	US
Telephone Number	:	817-255-2652
Fax Number	:	817-255-2657

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	06/22/2021

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Directions to “ MADISON MARIE LOWRIE ” Practice Location

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