Provider Demographics
NPI:1396373361
Name:JJ LOTUS THERAPY LOUNGE, LLC
Entity Type:Organization
Organization Name:JJ LOTUS THERAPY LOUNGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:CONTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:321-412-0653
Mailing Address - Street 1:15310 AMBERLY DR STE 250
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1642
Mailing Address - Country:US
Mailing Address - Phone:813-683-8197
Mailing Address - Fax:813-336-8286
Practice Address - Street 1:15310 AMBERLY DR STE 250
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-1642
Practice Address - Country:US
Practice Address - Phone:321-412-0653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-27
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)