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General NPI Number Information
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NPI Number | 1750036331
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Entity Type | Organization
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Legal Business Name | BLUE LOTUS NEUROPSYCHOLOGY, PLLC
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Dates
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Enumeration Date | 02/13/2022
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 636 CHURCH ST STE 307
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City | EVANSTON
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State | IL
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Zip | 60201-4579
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Country | US
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Telephone | 847-220-4365
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Fax |
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Provider Business Mailing Address
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Address Line | 636 CHURCH ST STE 307
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City | EVANSTON
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State | IL
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Zip | 60201-4579
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Country | US
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Telephone | 847-220-4365
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. CHELSEA COOPER
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Credential | PSY.D.
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Telephone | 847-220-4365
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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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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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