Basic Information
| Provider Information | |||||||||
| NPI: | 1528459930 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOWE | ||||||||
| FirstName: | KASEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SIEMSSEN | ||||||||
| OtherFirstName: | KASEY | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 516A N HORTON PKWY | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370343310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049314699 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Practice Location | |||||||||
| Address1: | 516A N HORTON PKWY | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370343310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5049314699 | ||||||||
| FaxNumber: | 9543420273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2015 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 816 | TN | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 103K00000X | 1-15-21059 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.