Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY.0005495 | CO |
Y | 103TC0700X | Clinical Psychologist | PSY.0005495 | CO |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 37747 | TX |
NPI | 1053820068 |
---|---|
Provider Name | Dr. Mark Anthon Lott |
First Address | Johnstown, CO 80534-7827 |
Second Address | Loveland, CO 80538-9086 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 23/09/2021 |