MEDICARE: LOTUS CHILD AND FAMILY THERAPY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1407444805
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOTUS CHILD AND FAMILY THERAPY

Provider Business Mailing Address
First Line	:	8000 E PRENTICE AVE STE B5
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	505-504-0103
Fax Number	:	720-542-9230

Provider Business Practice Location Address
First Line	:	8000 E PRENTICE AVE STE B5
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2726
Country	:	US
Telephone Number	:	505-504-0103
Fax Number	:	720-542-9230

Authorized Official
Title or Position	:	LCSW/OWNER
Name	:	LORI DERR
Credential	:	LCSW
Telephone Number	:	505-504-0103

Provider Enumeration Date	:	01/02/2021
Last Update Date	:	01/02/2021

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