Provider Demographics
NPI:1689309577
Name:LOWERY, MAISHA (LCPC)
Entity Type:Individual
Prefix:
First Name:MAISHA
Middle Name:
Last Name:LOWERY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 MAIN ST UNIT 6389
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60204-3236
Mailing Address - Country:US
Mailing Address - Phone:708-890-1104
Mailing Address - Fax:
Practice Address - Street 1:550 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3100
Practice Address - Country:US
Practice Address - Phone:708-890-1104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014523101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty