Provider Demographics
NPI:1649754797
Name:BLOOMING LOTUS COUNSELING LLC
Entity Type:Organization
Organization Name:BLOOMING LOTUS COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:PASHA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:330-307-8948
Mailing Address - Street 1:3227 GREENLAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1261
Mailing Address - Country:US
Mailing Address - Phone:330-307-8948
Mailing Address - Fax:
Practice Address - Street 1:135 W SWALLOW RD BLDG B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2563
Practice Address - Country:US
Practice Address - Phone:330-307-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty