Healthcare Provider Details

I. General information

NPI: 1295567253
Provider Name (Legal Business Name): THE SMILING LOTUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 N MAIN ST # 202
ROSWELL NM
88201-4724
US

IV. Provider business mailing address

327 N MAIN ST # 202
ROSWELL NM
88201-4724
US

V. Phone/Fax

Practice location:
  • Phone: 575-244-4472
  • Fax:
Mailing address:
  • Phone: 575-244-4472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARTHA VILLARREAL
Title or Position: OWNER
Credential: LCSW
Phone: 505-328-1471