MEDICARE: BLOOMING LOTUS 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	:	1649754797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLOOMING LOTUS COUNSELING LLC

Provider Business Mailing Address
First Line	:	3227 GREENLAKE DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-1261
Country	:	US
Telephone Number	:	330-307-8948
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 W SWALLOW RD BLDG B
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-2563
Country	:	US
Telephone Number	:	330-307-8948
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	MS. LAURA MICHELLE PASHA
Credential	:	LPC
Telephone Number	:	330-307-8948

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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