Provider Demographics
NPI:1366420796
Name:LOWMAN, TENEA M (PSYD)
Entity type:Individual
Prefix:
First Name:TENEA
Middle Name:M
Last Name:LOWMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TENEA
Other - Middle Name:M
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:613 S STATE FAIR BLVD
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2415
Mailing Address - Country:US
Mailing Address - Phone:660-647-2182
Mailing Address - Fax:660-647-2217
Practice Address - Street 1:307 N. MAIN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:MO
Practice Address - Zip Code:65360
Practice Address - Country:US
Practice Address - Phone:660-647-2182
Practice Address - Fax:660-647-2217
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006029885103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist