MEDICARE: PINK LOTUS HEALING

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1700500717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINK LOTUS HEALING

Provider Business Mailing Address
First Line	:	2526 FRIENDLY ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-2251
Country	:	US
Telephone Number	:	541-953-2632
Fax Number	:

Provider Business Practice Location Address
First Line	:	345 W 13TH AVE RM 2
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-3483
Country	:	US
Telephone Number	:	541-953-2632
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	DANA FLEMING
Credential	:	MSW, LCSW, CADC L
Telephone Number	:	541-953-2632

Provider Enumeration Date	:	10/03/2022
Last Update Date	:	10/03/2022

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Directions to “PINK LOTUS HEALING ” Practice Location

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