Provider Demographics
NPI:1508592890
Name:DESERT LOTUS HEALING THERAPY LLC
Entity Type:Organization
Organization Name:DESERT LOTUS HEALING THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRESEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-741-0472
Mailing Address - Street 1:4 MANZANO VIEJO
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529-5044
Mailing Address - Country:US
Mailing Address - Phone:575-741-0472
Mailing Address - Fax:
Practice Address - Street 1:4 MANZANO VIEJO
Practice Address - Street 2:
Practice Address - City:EL PRADO
Practice Address - State:NM
Practice Address - Zip Code:87529-5044
Practice Address - Country:US
Practice Address - Phone:575-741-0472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty