MEDICARE: LOTUS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1972077527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS COUNSELING, LLC

Provider Business Mailing Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3941
Country	:	US
Telephone Number	:	608-618-5560
Fax Number	:	855-277-9589

Provider Business Practice Location Address
First Line	:	32 S MAIN ST
Second Line	:
City	:	JANESVILLE
State	:	WI
Zip	:	53545-3941
Country	:	US
Telephone Number	:	608-618-5560
Fax Number	:	855-277-9589

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	KRYSTAL A CONKLE
Credential	:	MSW, LCSW
Telephone Number	:	608-618-5560

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	10/16/2023

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