Provider Demographics
NPI:1124797345
Name:LOTUS CLINICAL COUNSELING SERVICES
Entity type:Organization
Organization Name:LOTUS CLINICAL COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BARRY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:518-703-2519
Mailing Address - Street 1:1873 WESTERN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-5028
Mailing Address - Country:US
Mailing Address - Phone:518-703-2519
Mailing Address - Fax:
Practice Address - Street 1:1873 WESTERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-5028
Practice Address - Country:US
Practice Address - Phone:518-703-2519
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty