| Doctor Name: | WES BAZIL LOTHERY |
| NPI Number: | 1881735900 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.ED. |
| License Number: | 1885 |
| Business Practice Address: | 111 W Pine Grove Rd Fair Play, SC - 296430295 |
| Business Phone Number: | 8649729310 |
| Business Fax Number: | |
| Mailing Address: | Po Box 295, FAIR PLAY |
| State: | SC |
| Postal Code: | 296430295 |
| Phone Number: | 8649729310 |
| Fax Number: | |
| NPI Enumeration Date: | 02/09/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 1885 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |