Healthcare Provider Details

I. General information

NPI: 1205709532
Provider Name (Legal Business Name): BLUE LOTUS COUNSELING AND WELLNESS CENER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 PROSPECT ST
MANCHESTER NH
03104-3506
US

IV. Provider business mailing address

66 PROSPECT ST
MANCHESTER NH
03104-3506
US

V. Phone/Fax

Practice location:
  • Phone: 603-270-9217
  • Fax: 603-232-1376
Mailing address:
  • Phone: 603-270-9217
  • Fax: 603-232-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY SIEPER
Title or Position: OWNER
Credential: LCMHC, MLADC
Phone: 603-270-9217