Provider Demographics
NPI:1548226202
Name:LOTT, GREGORY (CSW)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:LOTT
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:830 W LAKE LANSING RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-6372
Mailing Address - Country:US
Mailing Address - Phone:517-624-1416
Mailing Address - Fax:517-237-4170
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:STE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-882-3732
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010832371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical