Provider Demographics
NPI:1639752785
Name:LOWELL, JASON DAVID (LPC)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DAVID
Last Name:LOWELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 AMBERWOOD WEST DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8316
Mailing Address - Country:US
Mailing Address - Phone:616-550-6134
Mailing Address - Fax:
Practice Address - Street 1:2305 E PARIS AVE SE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2426
Practice Address - Country:US
Practice Address - Phone:616-816-1758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223760101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health