Provider Demographics
NPI:1104071307
Name:LOWRY, MATTHEW C (LPP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:LOWRY
Suffix:
Gender:M
Credentials:LPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 OLYMPIA DR
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2111
Mailing Address - Country:US
Mailing Address - Phone:502-286-0556
Mailing Address - Fax:
Practice Address - Street 1:120 SEARS AVE STE 202
Practice Address - Street 2:
Practice Address - City:ST MATTHEWS
Practice Address - State:KY
Practice Address - Zip Code:40207-5072
Practice Address - Country:US
Practice Address - Phone:502-265-6790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY168059103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100408230Medicaid