MEDICARE: LOTUS PROFESSIONAL COUNSELING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401012768	MI

General Provider Information

NPI Number	:	1174038913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS PROFESSIONAL COUNSELING LLC

Provider Business Mailing Address
First Line	:	1108 W 11 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2453
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1108 W 11 MILE RD
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-2453
Country	:	US
Telephone Number	:	586-960-5283
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	KATHRYN ZABIK
Credential	:	MA, LPC, NCC
Telephone Number	:	586-960-5283

Provider Enumeration Date	:	12/01/2017
Last Update Date	:	12/01/2017

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