Healthcare Provider Details

I. General information

NPI: 1477249456
Provider Name (Legal Business Name): LOTUS VALLEY HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 CENTRAL AVE STE K
HOT SPRINGS AR
71901-6898
US

IV. Provider business mailing address

1513 ASH ST
TEXARKANA AR
71854-4227
US

V. Phone/Fax

Practice location:
  • Phone: 501-463-6969
  • Fax: 501-915-1557
Mailing address:
  • Phone: 870-774-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TRACY TERWILLIGER
Title or Position: PRESIDENT/CEO
Credential: LPC
Phone: 501-463-6969