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General NPI Number Information
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NPI Number | 1083432686
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Entity Type | Organization
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Legal Business Name | LOTUS HOLISTIC HEALTHCARE
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 22424 S ELLSWORTH LOOP RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7026
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Country | US
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Telephone | 602-492-7632
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Fax |
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Provider Business Mailing Address
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Address Line | 22424 S ELLSWORTH LOOP RD
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-7026
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Country | US
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Telephone | 602-492-7632
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MARY ANN SMITH
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Credential |
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Telephone | 602-492-7632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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