Basic Information
| Provider Information | |||||||||
| NPI: | 1437542446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOTZ | ||||||||
| FirstName: | ELIJAH | ||||||||
| MiddleName: | JOHN STRONG | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 955 POWELL AVE SW | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980572908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252771311 | ||||||||
| FaxNumber: | 4252771566 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S 2ND ST | ||||||||
| Address2: | |||||||||
| City: | RENTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980572007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254246310 | ||||||||
| FaxNumber: | 4252771566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2015 | ||||||||
| LastUpdateDate: | 12/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY60764108 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.