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General NPI Number Information
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NPI Number | 1841893682
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Entity Type | Organization
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Legal Business Name | LOTUS INTEGRATIVE BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 1 EAST MERCHANTS DRIVE
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City | OSWEGO
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State | IL
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Zip | 60543
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Country | US
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Telephone | 305-518-6846
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Fax |
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Provider Business Mailing Address
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Address Line | 1905 MARKETVIEW DR UNIT 256
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City | YORKVILLE
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State | IL
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Zip | 60560-1896
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Country | US
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Telephone | 603-551-8684
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE M MCDONALD
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Credential | LCSW
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Telephone | 630-551-8684
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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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