Provider Demographics
NPI:1245698224
Name:LOTUS CIRCLE COUNSELING SERVICES
Entity type:Organization
Organization Name:LOTUS CIRCLE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LU
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:714-623-7716
Mailing Address - Street 1:PO BOX 8364
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8364
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10221 SLATER AVE STE 205
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4744
Practice Address - Country:US
Practice Address - Phone:714-623-7716
Practice Address - Fax:562-261-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-04
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT86374251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health