Provider Demographics
NPI:1629589106
Name:LOWERY, ROY A
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:LOWERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14572 US HIGHWAY 23 STE A
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9448
Mailing Address - Country:US
Mailing Address - Phone:740-835-8083
Mailing Address - Fax:
Practice Address - Street 1:14572 US HIGHWAY 23 STE A
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9448
Practice Address - Country:US
Practice Address - Phone:740-835-8083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)