MEDICARE: DR. LOUIS R. LOTHMAN FL. LICENSED MARRIAG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor	3181
2	106H00000X	Marriage & Family Therapist	MT1294	FL

General Provider Information

NPI Number	:	1114467834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS R. LOTHMAN FL. LICENSED MARRIAG

Provider Business Mailing Address
First Line	:	3734 SAN VISCAYA DR.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217
Country	:	US
Telephone Number	:	904-631-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	3734 SAN VISCAYA DR.
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217
Country	:	US
Telephone Number	:	904-631-9198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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