Provider Demographics
NPI:1700356409
Name:RISING LOTUS HEALING LLC
Entity Type:Organization
Organization Name:RISING LOTUS HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:928-457-2727
Mailing Address - Street 1:PO BOX 1324
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-1324
Mailing Address - Country:US
Mailing Address - Phone:928-550-8002
Mailing Address - Fax:928-707-8500
Practice Address - Street 1:320 N LEROUX ST STE C
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4535
Practice Address - Country:US
Practice Address - Phone:928-550-8002
Practice Address - Fax:520-305-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)