Provider Demographics
NPI:1407863996
Name:LOWERY, MARY BETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:LOWERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 COLE ST
Mailing Address - Street 2:P.O. BOX 1492
Mailing Address - City:MENA
Mailing Address - State:AR
Mailing Address - Zip Code:71953-3719
Mailing Address - Country:US
Mailing Address - Phone:479-394-2013
Mailing Address - Fax:479-394-4805
Practice Address - Street 1:1706 HIGHWAY 71 N
Practice Address - Street 2:
Practice Address - City:MENA
Practice Address - State:AR
Practice Address - Zip Code:71953-8917
Practice Address - Country:US
Practice Address - Phone:479-394-4800
Practice Address - Fax:479-394-4805
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical