Provider Demographics
NPI:1790367704
Name:LOTUS RISING ATX, PLLC
Entity Type:Organization
Organization Name:LOTUS RISING ATX, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE PRACTICE THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-400-0103
Mailing Address - Street 1:5900 BALCONES DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4298
Mailing Address - Country:US
Mailing Address - Phone:512-400-0103
Mailing Address - Fax:
Practice Address - Street 1:5900 BALCONES DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4298
Practice Address - Country:US
Practice Address - Phone:512-400-0103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty