Healthcare Provider Details

I. General information

NPI: 1548747074
Provider Name (Legal Business Name): BLOOMING LOTUS COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 JUNGERMANN RD STE D
SAINT PETERS MO
63376-6962
US

IV. Provider business mailing address

1936 BONNIE BROOK LN
WENTZVILLE MO
63385-3265
US

V. Phone/Fax

Practice location:
  • Phone: 636-336-2996
  • Fax:
Mailing address:
  • Phone: 636-336-2996
  • Fax: 636-412-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number2012009912
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number2012009912
License Number StateMO

VIII. Authorized Official

Name: SARAH ELIZABETH LINN
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 636-336-2996