Provider Demographics
NPI:1659621852
Name:LOWELL, DOUGLAS (MSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:LOWELL
Suffix:
Gender:M
Credentials:MSW
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 36156
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-0156
Mailing Address - Country:US
Mailing Address - Phone:323-717-8117
Mailing Address - Fax:
Practice Address - Street 1:364 S CLOVERDALE AVE APT 103
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-6606
Practice Address - Country:US
Practice Address - Phone:323-717-8117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor