Healthcare Provider Details

I. General information

NPI: 1023966090
Provider Name (Legal Business Name): LOTUS PSYCHOTHERAPY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 HOLLING PL UNIT 407
FREDERICK MD
21701-5062
US

IV. Provider business mailing address

1301 HOLLING PL UNIT 407
FREDERICK MD
21701-5062
US

V. Phone/Fax

Practice location:
  • Phone: 417-268-0858
  • Fax:
Mailing address:
  • Phone: 417-268-0858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. SUSAN MCGILLOWAY
Title or Position: OWNER
Credential: LCPC
Phone: 417-268-0858