=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174394266
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNFOLDING THE LOTUS HEALING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2024
-----------------------------------------------------
Last Update Date | 01/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 455 DELTA AVE
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45226-1127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-549-1227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20464 LONGVIEW DR
-----------------------------------------------------
City | LAWRENCEBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47025-9019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-939-9236
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/THERAPIST
-----------------------------------------------------
Name | SHANDA INEZ MROZ
-----------------------------------------------------
Credential | LPCC, LICDC, NCC
-----------------------------------------------------
Telephone | 513-549-1227
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------