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General NPI Number Information
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NPI Number | 1124982152
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Entity Type | Organization
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Legal Business Name | LIONS HEART THERAPY PLLC
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Dates
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Enumeration Date | 12/13/2025
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 3064 190TH ST
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City | LANSING
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State | IL
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Zip | 60438-3473
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Country | US
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Telephone | 773-597-8544
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE 6059
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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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 | OWNER
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Name | CEDRIC BUSSIE
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Credential | LCPC
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Telephone | 773-597-8544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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