Provider Demographics
NPI:1508531203
Name:LOTUS BLOOM PSYCHOLOGY, LLC
Entity Type:Organization
Organization Name:LOTUS BLOOM PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:785-766-9272
Mailing Address - Street 1:924 W 75TH ST STE 120-293
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-6193
Mailing Address - Country:US
Mailing Address - Phone:785-766-9272
Mailing Address - Fax:
Practice Address - Street 1:362 W MADISON ST STE 120-293
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3218
Practice Address - Country:US
Practice Address - Phone:785-766-9272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)