Provider Demographics
NPI:1376097451
Name:LOTT, SHALEENA (MS)
Entity Type:Individual
Prefix:
First Name:SHALEENA
Middle Name:
Last Name:LOTT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4038 LAKE BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:MASCOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:34753-8877
Mailing Address - Country:US
Mailing Address - Phone:352-638-1151
Mailing Address - Fax:352-557-4091
Practice Address - Street 1:1060 W HIGHWAY 50 STE 212
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2835
Practice Address - Country:US
Practice Address - Phone:352-325-3603
Practice Address - Fax:352-557-4091
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-07
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health