Healthcare Provider Details

I. General information

NPI: 1124982152
Provider Name (Legal Business Name): LIONS HEART THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3064 190TH ST
LANSING IL
60438-3473
US

IV. Provider business mailing address

2501 CHATHAM RD STE 6059
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 773-597-8544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CEDRIC BUSSIE
Title or Position: OWNER
Credential: LCPC
Phone: 773-597-8544