Healthcare Provider Details

I. General information

NPI: 1477792513
Provider Name (Legal Business Name): JULIA DENISE LOTT PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 SHREVEPORT HWY # 71
PINEVILLE LA
71360-4044
US

IV. Provider business mailing address

2495 SHREVEPORT HWY # 71
PINEVILLE LA
71360-4044
US

V. Phone/Fax

Practice location:
  • Phone: 318-466-2286
  • Fax:
Mailing address:
  • Phone: 318-466-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1084
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number1084
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: