Active NPI
Shea Lott, PHD
- Clinical Psychologist
- Portland, OR
National Provider Identifier
1639566391
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2604
- Practice address
- 621 SW Alder St Ste 520
Portland, OR 97205-3620 - Phone
- (503) 494-4745
- Fax
- (503) 494-4747
- NPI assigned
- Apr 21, 2015
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | 2604 | OR | |
| Clinical Psychologist | 103TC0700X | 2604 | OR | Primary |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 2604 | OR | |
| Family Psychologist | 103TF0000X | 2604 | OR | |
| Group Psychotherapy Psychologist | 103TP2701X | 2604 | OR |
Addresses
Primary practice location
621 SW Alder St Ste 520
Portland, OR 97205-3620
Mailing address
621 SW Alder Street
Ste 520
Portland, OR 97205
Phone (503) 494-4745
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2604 | OR | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1429574400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1639566391",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "621 SW ALDER STREET",
"address_2": "STE 520",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97205",
"telephone_number": "503-494-4745",
"fax_number": "503-494-4747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "621 SW ALDER ST STE 520",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972053620",
"telephone_number": "503-494-4745",
"fax_number": "503-494-4747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOTT",
"first_name": "SHEA",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-04-21",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "OR",
"license": "2604",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "2604",
"primary": true
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OR",
"license": "2604",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "OR",
"license": "2604",
"primary": false
},
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": "OR",
"license": "2604",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.