Provider Demographics
NPI:1194492926
Name:STOTTLER, LORI JEAN (LMHC)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:JEAN
Last Name:STOTTLER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 BLAKEY BLVD
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-2803
Mailing Address - Country:US
Mailing Address - Phone:321-347-4705
Mailing Address - Fax:
Practice Address - Street 1:457 BLAKEY BLVD
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-2803
Practice Address - Country:US
Practice Address - Phone:321-347-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-28
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health