Provider Demographics
NPI:1619283637
Name:LOWE, MARY KAY (LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:LOWE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:LOWE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:5426 EDGEWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:MPLS
Mailing Address - State:MN
Mailing Address - Zip Code:55417
Mailing Address - Country:US
Mailing Address - Phone:612-978-7917
Mailing Address - Fax:612-861-3446
Practice Address - Street 1:339 BARRY AVE SO
Practice Address - Street 2:#281
Practice Address - City:WAYZATA
Practice Address - State:MN
Practice Address - Zip Code:55391
Practice Address - Country:US
Practice Address - Phone:612-481-0643
Practice Address - Fax:612-861-3446
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2012106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist