Provider Demographics
NPI:1548747074
Name:BLOOMING LOTUS COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:BLOOMING LOTUS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:636-336-2996
Mailing Address - Street 1:1936 BONNIE BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3265
Mailing Address - Country:US
Mailing Address - Phone:636-336-2996
Mailing Address - Fax:636-412-1559
Practice Address - Street 1:1236 JUNGERMANN RD STE D
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-6962
Practice Address - Country:US
Practice Address - Phone:636-336-2996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012009912261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health