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General NPI Number Information
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NPI Number | 1477249456
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Entity Type | Organization
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Legal Business Name | LOTUS VALLEY HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 04/13/2023
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Last Update Date | 04/13/2023
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Provider Practice Location Address
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Address Line | 1820 CENTRAL AVE STE K
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City | HOT SPRINGS
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State | AR
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Zip | 71901-6898
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Country | US
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Telephone | 501-463-6969
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Fax | 501-915-1557
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Provider Business Mailing Address
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Address Line | 1513 ASH ST
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City | TEXARKANA
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State | AR
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Zip | 71854-4227
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Country | US
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Telephone | 870-774-4016
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | TRACY TERWILLIGER
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Credential | LPC
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Telephone | 501-463-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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