Provider Demographics
NPI:1609267475
Name:STEPHEN C. LOTT, PSY.D. LLC
Entity Type:Organization
Organization Name:STEPHEN C. LOTT, PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOTT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:850-764-5431
Mailing Address - Street 1:105 E GREGORY SQ
Mailing Address - Street 2:SUITE G
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-4971
Mailing Address - Country:US
Mailing Address - Phone:850-764-5431
Mailing Address - Fax:850-659-2159
Practice Address - Street 1:105 E GREGORY SQ
Practice Address - Street 2:SUITE G
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4971
Practice Address - Country:US
Practice Address - Phone:850-764-5431
Practice Address - Fax:850-659-2159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4497208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty