Provider Demographics
NPI:1043867377
Name:LOTTINGER, KAY HAYNES
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:HAYNES
Last Name:LOTTINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4766 SUE BELLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-2566
Mailing Address - Country:US
Mailing Address - Phone:318-617-7176
Mailing Address - Fax:
Practice Address - Street 1:4766 SUE BELLE LAKE RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-2566
Practice Address - Country:US
Practice Address - Phone:318-617-7176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional