Healthcare Provider Details

I. General information

NPI: 1669264958
Provider Name (Legal Business Name): GREEN LOTUS THERAPY & CONSULTING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 5TH ST STE B
CLOVIS CA
93612-1058
US

IV. Provider business mailing address

312 5TH ST STE B
CLOVIS CA
93612-1058
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-0395
  • Fax:
Mailing address:
  • Phone: 559-712-0395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY GREEN
Title or Position: OWNER
Credential: MS, LMFT
Phone: 559-712-0395