Provider Demographics
NPI:1023424116
Name:LOTUS HOUSE CLINICAL SERVICES, LLC
Entity type:Organization
Organization Name:LOTUS HOUSE CLINICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-459-6321
Mailing Address - Street 1:714 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-3321
Mailing Address - Country:US
Mailing Address - Phone:830-792-4673
Mailing Address - Fax:830-792-5673
Practice Address - Street 1:714 CLAY ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3321
Practice Address - Country:US
Practice Address - Phone:830-792-4673
Practice Address - Fax:830-792-5673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3750-3751251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health