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General NPI Number Information
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NPI Number | 1891095410
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Entity Type | Organization
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Legal Business Name | LOTUS BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 08/21/2011
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Provider Practice Location Address
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Address Line | 16040 CHRISTENSEN RD SUITE 209
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City | TUKWILA
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State | WA
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Zip | 98188-2934
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Country | US
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Telephone | 206-328-8889
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Fax | 206-328-8884
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Provider Business Mailing Address
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Address Line | PO BOX 84625
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City | SEATTLE
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State | WA
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Zip | 98124-5925
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Country | US
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Telephone | 206-328-8889
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Fax | 206-328-8884
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. THERESA LOCK
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Credential | PH.D.
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Telephone | 206-328-8889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW00009478
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY3514
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License Number State | WA
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