Provider Demographics
NPI:1942571963
Name:LOWE, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:BOLEJACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCP, LPC
Mailing Address - Street 1:2836 N. KELLY AVE APT. 105
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-5836
Mailing Address - Country:US
Mailing Address - Phone:405-880-3499
Mailing Address - Fax:405-509-5512
Practice Address - Street 1:1409 S MAIN ST
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5836
Practice Address - Country:US
Practice Address - Phone:405-880-3499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional