| Lotus Waves, Ltd | |
|
3675 Sims Dr Decatur IL 62526-9203 | |
| (217) 412-3017 | |
| Not Available |
| Full Name | Lotus Waves, Ltd |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3675 Sims Dr, Decatur, Illinois |
| Authorized Official Name and Position | Brooke Elizabeth Nicol (PRESIDENT) |
| Authorized Official Contact | 2174123017 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Waves, Ltd 3675 Sims Dr Decatur IL 62526-9203 Ph: (217) 412-3017 | Lotus Waves, Ltd 3675 Sims Dr Decatur IL 62526-9203 Ph: (217) 412-3017 |
| NPI Number | 1639761398 |
|---|---|
| Provider Enumeration Date | 02/04/2021 |
| Last Update Date | 02/04/2021 |
| Certification Date | 02/04/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639761398 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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