Basic Information
| Provider Information | |||||||||
| NPI: | 1639566391 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOTT | ||||||||
| FirstName: | SHEA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 621 SW ALDER STREET | ||||||||
| Address2: | STE 520 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944745 | ||||||||
| FaxNumber: | 5034944747 | ||||||||
| Practice Location | |||||||||
| Address1: | 621 SW ALDER ST STE 520 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972053620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034944745 | ||||||||
| FaxNumber: | 5034944747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103G00000X | 2604 | OR | N | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC2200X | 2604 | OR | N | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TF0000X | 2604 | OR | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TP2701X | 2604 | OR | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | 103TC0700X | 2604 | OR | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.