Provider Demographics
NPI:1538940721
Name:OTT, DEBRA LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:LYNN
Last Name:OTT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 HONEYBEE DR
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8699
Mailing Address - Country:US
Mailing Address - Phone:724-709-3319
Mailing Address - Fax:
Practice Address - Street 1:1260 FREEDOM CRIDER RD STE 3
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:PA
Practice Address - Zip Code:15042-9391
Practice Address - Country:US
Practice Address - Phone:724-709-3319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC016188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional