Provider Demographics
NPI:1427797265
Name:LOTUS VALLEY HEALTH AND WELLNESS, LLC
Entity type:Organization
Organization Name:LOTUS VALLEY HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:TERWILLIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:501-520-8696
Mailing Address - Street 1:291 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6968
Mailing Address - Country:US
Mailing Address - Phone:501-520-8696
Mailing Address - Fax:
Practice Address - Street 1:1820 CENTRAL AVE STE K
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-6898
Practice Address - Country:US
Practice Address - Phone:501-463-6969
Practice Address - Fax:501-915-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-31
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty