Healthcare Provider Details

I. General information

NPI: 1255145215
Provider Name (Legal Business Name): MINDFUL LOTUS COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2025
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 MAIN ST STE 256
BETHLEHEM PA
18018-5881
US

IV. Provider business mailing address

559 MAIN ST STE 256
BETHLEHEM PA
18018-5881
US

V. Phone/Fax

Practice location:
  • Phone: 484-505-8640
  • Fax:
Mailing address:
  • Phone: 484-505-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TARA A SMITH
Title or Position: OWNER
Credential:
Phone: 484-505-8640