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General NPI Number Information
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NPI Number | 1154433191
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Entity Type | Organization
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Legal Business Name | ALICE LOTTES, PH.D.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4201 MARATHON BLVD STE 206
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City | AUSTIN
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State | TX
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Zip | 78756-3409
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Country | US
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Telephone | 512-451-3496
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Fax | 512-451-3498
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Provider Business Mailing Address
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Address Line | 4201 MARATHON BLVD STE 206
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City | AUSTIN
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State | TX
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Zip | 78756-3409
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Country | US
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Telephone | 512-451-3496
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Fax | 512-451-3498
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Authorized Official
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Title or Position | DIRECTOR
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Name | ALICE LOTTES
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Credential | PH.D.
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Telephone | 512-451-3496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31930
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License Number State | TX
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