Healthcare Provider Details

I. General information

NPI: 1043413537
Provider Name (Legal Business Name): GREGG LOTT LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 E 1400 S
OREM UT
84097-7714
US

IV. Provider business mailing address

PO BOX 522
PLEASANT GROVE UT
84062-0522
US

V. Phone/Fax

Practice location:
  • Phone: 801-426-6661
  • Fax: 801-426-6660
Mailing address:
  • Phone: 801-380-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1368553501
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: