Provider Demographics
NPI:1215915376
Name:LICHTI, LOU A (PHD)
Entity type:Individual
Prefix:DR
First Name:LOU
Middle Name:A
Last Name:LICHTI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E PATRICK ST # 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-5993
Mailing Address - Country:US
Mailing Address - Phone:301-401-2813
Mailing Address - Fax:
Practice Address - Street 1:25 E PATRICK ST FL 2
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5993
Practice Address - Country:US
Practice Address - Phone:301-401-2813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
MD2139103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TP2701X
MD02139103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGH74Medicare ID - Type Unspecified