Provider Demographics
NPI:1598531204
Name:LIGHT & LOTUS WELLNESS PLLC
Entity Type:Organization
Organization Name:LIGHT & LOTUS WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOSTETTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:720-515-4710
Mailing Address - Street 1:202 6TH ST STE 301E
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-1731
Mailing Address - Country:US
Mailing Address - Phone:720-515-4710
Mailing Address - Fax:
Practice Address - Street 1:202 6TH ST STE 301E
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1731
Practice Address - Country:US
Practice Address - Phone:720-515-4710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty