Provider Demographics
NPI:1831566256
Name:LOWE, KIMBERLY (LLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:LOWE
Suffix:
Gender:
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 HAGGERTY RD UNIT 731
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-5031
Mailing Address - Country:US
Mailing Address - Phone:734-634-6053
Mailing Address - Fax:
Practice Address - Street 1:9333 BEECHCREST ST
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-3207
Practice Address - Country:US
Practice Address - Phone:734-634-6053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MI6361000161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist