Organization
BLUE LOTUS THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. AMANDA LYNN JENNINGS LISW (PSYCHOTHERAPIST)
(614) 405-1234
Entity
Organization
Contact information
Practice address
14212 GEORGE ICE RD, GLENFORD, OH 43739-9701
(614) 405-1234
Mailing address
PO BOX 278, GLENFORD, OH 43739-0278
(614) 405-1234
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/22/2022
Last updated
05/26/2022
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