Provider Demographics
NPI:1013037373
Name:LOTT, TAMARA MARIE (LCPC, CRC)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:MARIE
Last Name:LOTT
Suffix:
Gender:F
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 N PEPPERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3273
Mailing Address - Country:US
Mailing Address - Phone:309-256-0114
Mailing Address - Fax:309-655-4609
Practice Address - Street 1:515 NE GLEN OAK AVE STE 101
Practice Address - Street 2:OSF SAINT FRANCIS MEDICAL CENTER
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3167
Practice Address - Country:US
Practice Address - Phone:309-655-7795
Practice Address - Fax:309-655-4609
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-003547101Y00000X
IL180003547101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor