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General NPI Number Information
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NPI Number | 1407120579
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Entity Type | Organization
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Legal Business Name | THE LOTUS COLLABORATIVE, INC., A PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 06/07/2023
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Provider Practice Location Address
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Address Line | 2125 DELAWARE AVE STE A
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City | SANTA CRUZ
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State | CA
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Zip | 95060-5752
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Country | US
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Telephone | 831-588-0497
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Fax | 831-600-7499
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Provider Business Mailing Address
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Address Line | 2125 DELAWARE AVE STE A
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City | SANTA CRUZ
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State | CA
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Zip | 95060-5752
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Country | US
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Telephone | 831-588-0497
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Fax | 831-600-7499
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. ELIZABETH ESALEN
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Credential | PSYD
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Telephone | 831-600-7103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24204
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License Number State | CA
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