Provider Demographics
NPI:1083139406
Name:LOTUS TRAUMA CARE, LLC
Entity Type:Organization
Organization Name:LOTUS TRAUMA CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER, TRAUMA THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHAUNTAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-201-0838
Mailing Address - Street 1:503 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-2406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:503 E 61ST ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2406
Practice Address - Country:US
Practice Address - Phone:872-233-8207
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health