Provider Demographics
NPI:1558403592
Name:LOWE, RICHARD (MFT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:LOWE
Suffix:
Gender:M
Credentials:MFT
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 411
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94915-0411
Mailing Address - Country:US
Mailing Address - Phone:415-485-5457
Mailing Address - Fax:415-482-8826
Practice Address - Street 1:412 RED HILL AVE
Practice Address - Street 2:SUITE #18
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2450
Practice Address - Country:US
Practice Address - Phone:415-485-5457
Practice Address - Fax:415-482-8826
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 24018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist