Healthcare Provider Details

I. General information

NPI: 1740978071
Provider Name (Legal Business Name): SAGE & LOTUS HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5607 STONYBROOK DR
PLAINFIELD IL
60586-6674
US

IV. Provider business mailing address

5607 STONYBROOK DR
PLAINFIELD IL
60586-6674
US

V. Phone/Fax

Practice location:
  • Phone: 815-593-4738
  • Fax:
Mailing address:
  • Phone: 815-593-4738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE HARTHUN
Title or Position: LCSW/OWNER
Credential:
Phone: 815-593-4738