Healthcare Provider Details

I. General information

NPI: 1184334781
Provider Name (Legal Business Name): LOTUS COUNSELING AND FAMILY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5699 E 71ST ST STE 2A
INDIANAPOLIS IN
46220-3950
US

IV. Provider business mailing address

5699 E 71ST ST STE 2A
INDIANAPOLIS IN
46220-3950
US

V. Phone/Fax

Practice location:
  • Phone: 574-326-0989
  • Fax:
Mailing address:
  • Phone: 574-326-0989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MISS VANESSA IDONA
Title or Position: OWNER
Credential: LCSW
Phone: 929-302-6163