Provider Demographics
NPI:1386851624
Name:ADAMS, LOWELL WALTER JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:WALTER
Last Name:ADAMS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OAK DR S
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-5676
Mailing Address - Country:US
Mailing Address - Phone:979-297-8565
Mailing Address - Fax:979-299-0196
Practice Address - Street 1:201 OAK DR S
Practice Address - Street 2:SUITE 203A
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5676
Practice Address - Country:US
Practice Address - Phone:979-297-8565
Practice Address - Fax:979-299-0196
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23826103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038923101Medicaid