Provider Demographics
NPI:1235685504
Name:LOTUS BEHAVIORAL CONSULTATION
Entity Type:Organization
Organization Name:LOTUS BEHAVIORAL CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED BEHAVIORAL ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MALCHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA
Authorized Official - Phone:860-420-9253
Mailing Address - Street 1:3 RAYMOND STREET
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066
Mailing Address - Country:US
Mailing Address - Phone:860-420-9253
Mailing Address - Fax:
Practice Address - Street 1:3 RAYMOND STREET
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066
Practice Address - Country:US
Practice Address - Phone:860-420-9253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services