Provider Demographics
NPI:1154078228
Name:LOTT, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOTT
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 1:3139 W HOLCOMBE BLVD STE 2025
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1533
Mailing Address - Country:US
Mailing Address - Phone:210-409-7792
Mailing Address - Fax:
Practice Address - Street 1:222 W 9TH ST
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:TX
Practice Address - Zip Code:78164-3497
Practice Address - Country:US
Practice Address - Phone:210-409-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80603101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional