Provider Demographics
NPI:1871231571
Name:MINDFUL LOTUS THERAPY INC
Entity Type:Organization
Organization Name:MINDFUL LOTUS THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:OJEDA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, C-DBT
Authorized Official - Phone:754-248-9589
Mailing Address - Street 1:6990 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4345
Mailing Address - Country:US
Mailing Address - Phone:754-248-9589
Mailing Address - Fax:754-764-0054
Practice Address - Street 1:6990 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-4345
Practice Address - Country:US
Practice Address - Phone:754-248-9589
Practice Address - Fax:754-764-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-23
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114413700Medicaid