Provider Demographics
NPI:1194326603
Name:BLOTT, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:BLOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 MCDERMOTT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7736
Mailing Address - Country:US
Mailing Address - Phone:972-292-9469
Mailing Address - Fax:
Practice Address - Street 1:4040 MCDERMOTT RD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-7736
Practice Address - Country:US
Practice Address - Phone:972-292-9469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health