Provider Demographics
NPI:1356783401
Name:LOWELL, MEGAN J (BCBA)
Entity type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:J
Last Name:LOWELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:J
Other - Last Name:GROENHOF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:11037 WARNER AVE STE 339
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4007
Mailing Address - Country:US
Mailing Address - Phone:800-273-4292
Mailing Address - Fax:714-596-6274
Practice Address - Street 1:30233 SOUTHFIELD RD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1362
Practice Address - Country:US
Practice Address - Phone:800-273-4292
Practice Address - Fax:714-596-6274
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401000120103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst