Provider Demographics
NPI:1255935615
Name:THRIVING LOTUS FAMILY THERAPY GROUP, INC
Entity type:Organization
Organization Name:THRIVING LOTUS FAMILY THERAPY GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORJA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:661-673-3782
Mailing Address - Street 1:25146 MARKEL DR
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2351
Mailing Address - Country:US
Mailing Address - Phone:661-877-2737
Mailing Address - Fax:
Practice Address - Street 1:27955 SMYTH DR STE 109
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4045
Practice Address - Country:US
Practice Address - Phone:661-673-3782
Practice Address - Fax:661-383-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)