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General NPI Number Information
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NPI Number | 1780274316
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Entity Type | Organization
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Legal Business Name | LOTUS LIFE LLC
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Dates
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Enumeration Date | 01/18/2021
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 12310 S ACUFF LN
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City | OLATHE
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State | KS
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Zip | 66062-5909
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Country | US
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Telephone | 913-850-9969
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Fax |
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Provider Business Mailing Address
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Address Line | 11936 W 119TH ST STE 173
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2216
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY BAUGHER
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Credential |
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Telephone | 913-850-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) 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 | 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 #3
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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