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General NPI Number Information
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NPI Number | 1114467834
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Entity Type | Individual
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Provider Name | LOUIS R. LOTHMAN FL. LICENSED MARRIAG
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Gender | Male
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 3734 SAN VISCAYA DR.
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City | JACKSONVILLE
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State | FL
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Zip | 32217
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Country | US
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Telephone | 904-631-9198
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Fax |
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Provider Business Mailing Address
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Address Line | 3734 SAN VISCAYA DR.
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City | JACKSONVILLE
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State | FL
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Zip | 32217
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Country | US
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Telephone | 904-631-9198
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 3181
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT1294
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License Number State | FL
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