Provider Demographics
NPI:1942890959
Name:LOTTES, MATTHEW JAMES (BS)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JAMES
Last Name:LOTTES
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1447 HAZEN ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49507-3712
Mailing Address - Country:US
Mailing Address - Phone:517-290-8120
Mailing Address - Fax:
Practice Address - Street 1:421 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8136
Practice Address - Country:US
Practice Address - Phone:616-251-8162
Practice Address - Fax:616-327-4660
Is Sole Proprietor?:No
Enumeration Date:2021-01-23
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other