Healthcare Provider Details

I. General information

NPI: 1700356409
Provider Name (Legal Business Name): RISING LOTUS HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

V. Phone/Fax

Practice location:
  • Phone: 928-550-8002
  • Fax: 928-707-8500
Mailing address:
  • Phone: 928-550-8002
  • Fax: 928-707-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN TAYLOR
Title or Position: MANAGER
Credential: PMHNP-BC
Phone: 928-457-2727