Provider Demographics
NPI:1598530305
Name:PEACEFUL LOTUS THERAPY, LLC
Entity Type:Organization
Organization Name:PEACEFUL LOTUS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:608-440-9004
Mailing Address - Street 1:PO BOX 153
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-0153
Mailing Address - Country:US
Mailing Address - Phone:608-440-9004
Mailing Address - Fax:
Practice Address - Street 1:100 RIVER PL STE 260
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4043
Practice Address - Country:US
Practice Address - Phone:608-440-9004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty