=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669016432
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. FRAN LOTERY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2019
-----------------------------------------------------
Last Update Date | 11/04/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 WASHINGTON BLVD UNIT 304
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-5168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-689-2283
-----------------------------------------------------
Fax | 805-617-1735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 310 WASHINGTON BLVD UNIT 304
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-5168
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-689-2283
-----------------------------------------------------
Fax | 805-617-1735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | MFC15430
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------