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NPI Code Detail

MEDICARE: WHITE LOTUS THERAPY SERVICES LLC

MEDICARE: WHITE LOTUS THERAPY SERVICES 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
1261QM0855XAdolescent and Children Mental Health Clinic/Center
2261QM0850XAdult Mental Health Clinic/Center
3251S00000XCommunity/Behavioral Health Agency
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1134972094
Entity Type Code : Organization
Provider Name (Legal Business Name) : WHITE LOTUS THERAPY SERVICES LLC
Provider Business Mailing Address
First Line : 4115 E VALLEY AUTO DR STE 208
Second Line :
City : MESA
State : AZ
Zip : 85206-4612
Country : US
Telephone Number : 480-229-8140
Fax Number :
Provider Business Practice Location Address
First Line : 4115 E VALLEY AUTO DR STE 208
Second Line :
City : MESA
State : AZ
Zip : 85206-4612
Country : US
Telephone Number : 480-229-8140
Fax Number :
Authorized Official
Title or Position : OWNER
Name : KATHERINE GARCIA
Credential : LPC
Telephone Number : 480-229-8140
Provider Enumeration Date : 04/10/2024
Last Update Date : 12/11/2024

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Directions to “WHITE LOTUS THERAPY SERVICES LLC ” Practice Location

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