Provider Demographics
NPI:1114671757
Name:BLUE LOTUS INTEGRATIVE HEALTH AND WELLNESS LLC
Entity Type:Organization
Organization Name:BLUE LOTUS INTEGRATIVE HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROWE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-524-5134
Mailing Address - Street 1:PO BOX 329
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-0329
Mailing Address - Country:US
Mailing Address - Phone:508-524-5135
Mailing Address - Fax:
Practice Address - Street 1:681 FALMOUTH RD STE D22
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6314
Practice Address - Country:US
Practice Address - Phone:508-524-5135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-11
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty