Healthcare Provider Details

I. General information

NPI: 1003220401
Provider Name (Legal Business Name): LOTUS BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 CARLISLE BLVD NE
ALBUQUERQUE NM
87107-4532
US

IV. Provider business mailing address

1414 CORNELL DR NE
ALBUQUERQUE NM
87106-3702
US

V. Phone/Fax

Practice location:
  • Phone: 401-954-1397
  • Fax:
Mailing address:
  • Phone: 401-954-1397
  • Fax: 505-200-2177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MOLLY LEIGH MAZER
Title or Position: OWNER
Credential: LISW
Phone: 401-954-1397