Provider Demographics
NPI:1275384984
Name:LOTUS LIFE COUNSELING
Entity Type:Organization
Organization Name:LOTUS LIFE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JABAAY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-705-3849
Mailing Address - Street 1:7515 W MANITOBA DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2019
Mailing Address - Country:US
Mailing Address - Phone:708-705-3849
Mailing Address - Fax:
Practice Address - Street 1:7250 W COLLEGE DR
Practice Address - Street 2:
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1151
Practice Address - Country:US
Practice Address - Phone:708-705-3849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty