Provider Demographics
NPI:1245082486
Name:LOWENHIELM, FREDRIK CHRISTOFFER
Entity type:Individual
Prefix:
First Name:FREDRIK
Middle Name:CHRISTOFFER
Last Name:LOWENHIELM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRISTOFFER
Other - Middle Name:FREDRIK
Other - Last Name:LOWENHIELM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 S WOODLAWN AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-7647
Mailing Address - Country:US
Mailing Address - Phone:636-379-1779
Mailing Address - Fax:636-634-3496
Practice Address - Street 1:801 S WOODLAWN AVE STE 15
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7647
Practice Address - Country:US
Practice Address - Phone:636-379-1779
Practice Address - Fax:636-634-3496
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021040943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health