Provider Demographics
NPI:1518353028
Name:LOTT, ANDREA ELAINE
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:ELAINE
Last Name:LOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:ELAINE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:276 CANTEBURY DR
Mailing Address - Street 2:
Mailing Address - City:LEMOORE
Mailing Address - State:CA
Mailing Address - Zip Code:93245-4338
Mailing Address - Country:US
Mailing Address - Phone:559-816-2859
Mailing Address - Fax:
Practice Address - Street 1:6500 S MOONEY BLVD
Practice Address - Street 2:SUIT B
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9535
Practice Address - Country:US
Practice Address - Phone:559-685-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional