Provider Demographics
NPI:1477805190
Name:LOWRY, KYLIE RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:RAE
Last Name:LOWRY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:OH
Mailing Address - Zip Code:43517
Mailing Address - Country:US
Mailing Address - Phone:260-925-2017
Mailing Address - Fax:260-925-9713
Practice Address - Street 1:2355 E CEDAR CANYONS ROAD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9330
Practice Address - Country:US
Practice Address - Phone:260-925-2017
Practice Address - Fax:260-925-9713
Is Sole Proprietor?:No
Enumeration Date:2012-10-04
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001879A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist