Provider Demographics
NPI:1932522034
Name:LOWDER, RAEGAN A (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:RAEGAN
Middle Name:A
Last Name:LOWDER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 NE 135TH ST
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-5816
Mailing Address - Country:US
Mailing Address - Phone:580-591-1758
Mailing Address - Fax:
Practice Address - Street 1:601 NW FORT SILL BLVD
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-6601
Practice Address - Country:US
Practice Address - Phone:580-355-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional