Provider Demographics
NPI:1740919018
Name:HEALING LOTUS COUNSELING
Entity type:Organization
Organization Name:HEALING LOTUS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRODERICK
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:857-293-1321
Mailing Address - Street 1:6 LIBERTY SQ # 2462
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-5800
Mailing Address - Country:US
Mailing Address - Phone:857-293-1321
Mailing Address - Fax:
Practice Address - Street 1:6 LIBERTY SQ # 2462
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-5800
Practice Address - Country:US
Practice Address - Phone:857-293-1321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health