Provider Demographics
NPI:1710700612
Name:LOTT, JENNA MARIE (MED, LMHC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:LOTT
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4513 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1204
Mailing Address - Country:US
Mailing Address - Phone:253-888-9699
Mailing Address - Fax:
Practice Address - Street 1:7024 27TH ST W STE B
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-5216
Practice Address - Country:US
Practice Address - Phone:253-888-9699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA526033F101YS0200X
WA61622766101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool