Provider Demographics
NPI:1184389736
Name:LIVING LOTUS FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:LIVING LOTUS FAMILY THERAPY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PANICHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMFT, RPT
Authorized Official - Phone:858-522-9415
Mailing Address - Street 1:200 N VINEYARD BLVD
Mailing Address - Street 2:SUITE A325 - #5307
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817
Mailing Address - Country:US
Mailing Address - Phone:858-522-9415
Mailing Address - Fax:
Practice Address - Street 1:2277 DORIS MILLER LOOP APT D
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3696
Practice Address - Country:US
Practice Address - Phone:858-522-9415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty