Provider Demographics
NPI:1336638428
Name:BLUE LOTUS COUNSELING AND WELLNESS CENER, LLC
Entity Type:Organization
Organization Name:BLUE LOTUS COUNSELING AND WELLNESS CENER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIEPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-270-9220
Mailing Address - Street 1:66 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-3506
Mailing Address - Country:US
Mailing Address - Phone:603-270-9220
Mailing Address - Fax:
Practice Address - Street 1:66 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-270-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-04
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty