MEDICARE: LOTUS BLOSSOM COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1114468519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS BLOSSOM COUNSELING, LLC

Provider Business Mailing Address
First Line	:	10135 UNION PARK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4373
Country	:	US
Telephone Number	:	407-953-4453
Fax Number	:

Provider Business Practice Location Address
First Line	:	10135 UNION PARK DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4373
Country	:	US
Telephone Number	:	407-953-4453
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CLAUDIA SWONGER
Credential	:	LMHC
Telephone Number	:	407-953-4453

Provider Enumeration Date	:	03/17/2017
Last Update Date	:	03/17/2017

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