Provider Demographics
NPI:1982919916
Name:LOWE, PHILLIP T (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:T
Last Name:LOWE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:PHIL
Other - Middle Name:T
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:2893 QUEENS WAY
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-5347
Mailing Address - Country:US
Mailing Address - Phone:805-413-2151
Mailing Address - Fax:
Practice Address - Street 1:155 N OCCIDENTAL BLVD # 243
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4641
Practice Address - Country:US
Practice Address - Phone:213-382-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CARPS2012519225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist