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NPI Code Detail

MEDICARE: MINDFUL LOTUS THERAPY INC

MEDICARE: MINDFUL LOTUS THERAPY INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
21041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871231571
Entity Type Code : Organization
Provider Name (Legal Business Name) : MINDFUL LOTUS THERAPY INC
Provider Business Mailing Address
First Line : 6990 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4345
Country : US
Telephone Number : 754-248-9589
Fax Number : 754-764-0054
Provider Business Practice Location Address
First Line : 6990 GRIFFIN RD
Second Line :
City : DAVIE
State : FL
Zip : 33314-4345
Country : US
Telephone Number : 754-248-9589
Fax Number : 754-764-0054
Authorized Official
Title or Position : OWNER
Name : MRS. LEIGH DANA OJEDA
Credential : LCSW, C-DBT
Telephone Number : 754-248-9589
Provider Enumeration Date : 05/23/2022
Last Update Date : 01/20/2023

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