Healthcare Provider Details

I. General information

NPI: 1548797889
Provider Name (Legal Business Name): LOTUS PLACE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HILLCREST DR
CLINTON MS
39056-4309
US

IV. Provider business mailing address

PO BOX 361
CLINTON MS
39060-0361
US

V. Phone/Fax

Practice location:
  • Phone: 601-427-5158
  • Fax: 601-429-1615
Mailing address:
  • Phone: 601-427-5158
  • Fax: 601-429-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0552
License Number StateMS

VIII. Authorized Official

Name: JENNIFER SIGREST
Title or Position: MEMBER
Credential: LPC
Phone: 601-427-5158