Provider Demographics
NPI:1952180200
Name:BOTT, ANDREW S (LAC-T)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:S
Last Name:BOTT
Suffix:
Gender:M
Credentials:LAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 W ELLIOT RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5129
Mailing Address - Country:US
Mailing Address - Phone:480-590-4227
Mailing Address - Fax:
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-590-4227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-08042T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health