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General NPI Number Information
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NPI Number | 1558808923
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Entity Type | Organization
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Legal Business Name | LOTT BEHAVIORAL HEALTH, LTD.
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Dates
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Enumeration Date | 01/24/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 4300 COMMERCE CT SUITE 250
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City | LISLE
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State | IL
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Zip | 60532-3709
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Country | US
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Telephone | 630-730-5506
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 COMMERCE CT SUITE 250
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City | LISLE
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State | IL
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Zip | 60532-3709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID LOTT
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Credential |
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Telephone | 630-730-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 036107431
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License Number State | IL
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