Provider Demographics
NPI:1962808105
Name:LOWRANCE, JESSICA (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LOWRANCE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 S POWER RD STE 252
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3700
Mailing Address - Country:US
Mailing Address - Phone:602-675-6185
Mailing Address - Fax:602-599-5704
Practice Address - Street 1:1234 S POWER RD STE 252
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3700
Practice Address - Country:US
Practice Address - Phone:602-675-6185
Practice Address - Fax:602-675-6185
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-20658101YM0800X, 101YP2500X
AZLAC-16062101YP2500X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701013350OtherVIRGINIA DEPARTMENT OF HEALTH PROFESSIONALS BOARD OF COUNSELING
AZLPC-20658OtherARIZONA BOARD OF BEHAVIORAL HEALTH EXAMINERS