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General NPI Number Information
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NPI Number | 1255935615
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Entity Type | Organization
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Legal Business Name | THRIVING LOTUS FAMILY THERAPY GROUP, INC
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 27955 SMYTH DR STE 109
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City | VALENCIA
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State | CA
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Zip | 91355-4045
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Country | US
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Telephone | 661-673-3782
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Fax | 661-383-0138
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Provider Business Mailing Address
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Address Line | 25146 MARKEL DR
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City | NEWHALL
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State | CA
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Zip | 91321-2351
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Country | US
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Telephone | 661-877-2737
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEISHA BORJA
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Credential | LMFT
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Telephone | 661-673-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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