Healthcare Provider Details

I. General information

NPI: 1922934702
Provider Name (Legal Business Name): ZENKI LOTUS INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 HASTINGS ST
TRAVERSE CITY MI
49686-3435
US

IV. Provider business mailing address

503 HASTINGS ST
TRAVERSE CITY MI
49686-3435
US

V. Phone/Fax

Practice location:
  • Phone: 231-620-0472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL DEAGRO
Title or Position: OWNER/PRESIDENT
Credential: LPC
Phone: 231-620-0472