Provider Demographics
NPI:1013275494
Name:BOTTI, LISA ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:BOTTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5443 US HIGHWAY 89
Mailing Address - Street 2:
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412-8419
Mailing Address - Country:US
Mailing Address - Phone:406-738-4338
Mailing Address - Fax:
Practice Address - Street 1:1626 6TH AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-1720
Practice Address - Country:US
Practice Address - Phone:406-727-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical