Organization
BLUE LOTUS PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNE-MARIE NICOLAS PSY.D. (OWNER/PSYCHOLOGIST)
(773) 551-3916
Entity
Organization
Contact information
Practice address
1525 E 53RD ST, STE. 405, CHICAGO, IL 60615-4557
(773) 551-3916
Mailing address
1525 E 53RD ST, STE. 405, CHICAGO, IL 60615-4557
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.008505
IL
Other
Enumeration date
05/14/2014
Last updated
05/14/2014
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