Healthcare Provider Details

I. General information

NPI: 1205537784
Provider Name (Legal Business Name): LOTUS FLOWER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6666 4TH ST NW STE C-1
LOS RANCHOS NM
87107-6144
US

IV. Provider business mailing address

6666 4TH ST NW STE C-1
LOS RANCHOS NM
87107-6144
US

V. Phone/Fax

Practice location:
  • Phone: 505-463-0472
  • Fax: 505-312-7646
Mailing address:
  • Phone: 505-463-0472
  • Fax: 505-312-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA MARTINEZ BURR
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: PHD, LPCC, NCC
Phone: 505-463-0472