Provider Demographics
NPI:1174328777
Name:LOWE, MALIK DEVONTE (ML)
Entity type:Individual
Prefix:
First Name:MALIK
Middle Name:DEVONTE
Last Name:LOWE
Suffix:
Gender:
Credentials:ML
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-7113
Mailing Address - Country:US
Mailing Address - Phone:720-984-9777
Mailing Address - Fax:
Practice Address - Street 1:8811 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-7113
Practice Address - Country:US
Practice Address - Phone:720-984-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician