Healthcare Provider Details

I. General information

NPI: 1578807319
Provider Name (Legal Business Name): TINA RANE LOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TINA RANE JOHNSON

II. Dates (important events)

Enumeration Date: 11/17/2012
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3172 N RAINBOW BLVD # 5077
LAS VEGAS NV
89108-4534
US

IV. Provider business mailing address

3172 N RAINBOW BLVD # 5077
LAS VEGAS NV
89108-4534
US

V. Phone/Fax

Practice location:
  • Phone: 702-801-9628
  • Fax:
Mailing address:
  • Phone: 702-472-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: