Provider Demographics
NPI:1265147946
Name:LOTTES, AMY WEBB (LMHC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:WEBB
Last Name:LOTTES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 MEADOW HILL LOOP
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-5966
Mailing Address - Country:US
Mailing Address - Phone:843-324-7747
Mailing Address - Fax:
Practice Address - Street 1:5434 MEADOW HILL LOOP
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-5966
Practice Address - Country:US
Practice Address - Phone:843-324-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMX21777101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health