Healthcare Provider Details

I. General information

NPI: 1194031971
Provider Name (Legal Business Name): LOTUS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ASHLAND AVE STE 400
CHICAGO IL
60622-2259
US

IV. Provider business mailing address

1200 N ASHLAND AVE STE 401
CHICAGO IL
60622-2259
US

V. Phone/Fax

Practice location:
  • Phone: 773-850-2295
  • Fax:
Mailing address:
  • Phone: 773-850-2295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number180007383
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number178005052
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180007383
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178005052
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178005052
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007383
License Number StateIL

VIII. Authorized Official

Name: MS. HEATHER SHANNON
Title or Position: OWNER
Credential: LCPC
Phone: 773-850-2295