Provider Demographics
NPI:1255463485
Name:LOWEY, THERESA LYNN (MS, MFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNN
Last Name:LOWEY
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LYNN
Other - Last Name:PICKUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:1016 LA POSADA DRIVE,
Mailing Address - Street 2:SUITE 285
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3817
Mailing Address - Country:US
Mailing Address - Phone:512-206-0808
Mailing Address - Fax:512-206-0844
Practice Address - Street 1:1016 LA POSADA DRIVE,
Practice Address - Street 2:SUITE 285
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3817
Practice Address - Country:US
Practice Address - Phone:512-206-0808
Practice Address - Fax:512-206-0844
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMFT0678106H00000X
TX202126106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100508214Medicaid