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General NPI Number Information
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NPI Number | 1093256844
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Entity Type | Organization
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Legal Business Name | LOTUS HEALING, LLC
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Dates
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Enumeration Date | 03/13/2017
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Last Update Date | 03/13/2017
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Provider Practice Location Address
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Address Line | 1525 E HYDE PARK BLVD SUITE 525
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City | CHICAGO
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State | IL
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Zip | 60615-3043
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Country | US
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Telephone | 312-966-9545
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 E HYDE PARK BLVD SUITE 525
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City | CHICAGO
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State | IL
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Zip | 60615-3043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NYELA MALONE
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Credential | LCPC
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Telephone | 312-966-9545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180009790
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License Number State | IL
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