Provider Demographics
NPI:1033515796
Name:LOTUS BEHAVIORAL HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:LOTUS BEHAVIORAL HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ROEHRIG
Authorized Official - Last Name:TONDU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-420-6427
Mailing Address - Street 1:135 MONTGOMERY LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4924
Mailing Address - Country:US
Mailing Address - Phone:312-420-6427
Mailing Address - Fax:
Practice Address - Street 1:1910 1ST ST STE 302
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3146
Practice Address - Country:US
Practice Address - Phone:312-420-6427
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007970261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health