1114379112 NPI number — LOWRY COUNSELING LLC

Table of content: (NPI 1114379112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114379112 NPI number — LOWRY COUNSELING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOWRY COUNSELING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114379112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6105 S. MAIN ST. #219
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-319-7319
Provider Business Mailing Address Fax Number:
303-379-4607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6105 S. MAIN ST. #219 AURORA, CO 80016
Provider Second Line Business Practice Location Address:
2401 S. LOGAN ST.
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
720-319-7319
Provider Business Practice Location Address Fax Number:
303-379-4607
Provider Enumeration Date:
07/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
IOANNIDES
Authorized Official First Name:
JOANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
720-319-7319

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  992674 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31236014 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08105031 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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