Healthcare Provider Details

I. General information

NPI: 1588449094
Provider Name (Legal Business Name): NOELLE KRISTYN LOTHAMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3253 CONGRESS AVE
SAGINAW MI
48602-3106
US

IV. Provider business mailing address

31815 SOUTHFIELD RD
BEVERLY HILLS MI
48025-5471
US

V. Phone/Fax

Practice location:
  • Phone: 989-475-4171
  • Fax: 989-393-6021
Mailing address:
  • Phone: 248-480-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401226468
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: