Provider Demographics
NPI:1215088398
Name:LOWE, KATHLEEN (MA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:LOWE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KIMBARK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-5583
Mailing Address - Country:US
Mailing Address - Phone:303-651-1515
Mailing Address - Fax:720-652-0408
Practice Address - Street 1:500 KIMBARK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5583
Practice Address - Country:US
Practice Address - Phone:303-651-1515
Practice Address - Fax:720-652-0408
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001207106H00000X
COMFT 46106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist