Provider Demographics
NPI:1407120579
Name:THE LOTUS COLLABORATIVE, INC., A PSYCHOLOGY CLINIC
Entity Type:Organization
Organization Name:THE LOTUS COLLABORATIVE, INC., A PSYCHOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESALEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:831-600-7103
Mailing Address - Street 1:2125 DELAWARE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-5752
Mailing Address - Country:US
Mailing Address - Phone:831-588-0497
Mailing Address - Fax:831-600-7499
Practice Address - Street 1:2125 DELAWARE AVE STE A
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-5752
Practice Address - Country:US
Practice Address - Phone:831-588-0497
Practice Address - Fax:831-600-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24204103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225329253OtherNPI