Provider Demographics
NPI:1053820068
Name:LOTT, MARK ANTHON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHON
Last Name:LOTT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:464 GRANGE LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-7827
Mailing Address - Country:US
Mailing Address - Phone:720-615-8444
Mailing Address - Fax:720-844-3300
Practice Address - Street 1:1635 FOXTRAIL DR # 108
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9086
Practice Address - Country:US
Practice Address - Phone:720-615-8444
Practice Address - Fax:720-844-3300
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-21
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0005495103TC0700X, 103G00000X
TX37747103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty