Provider Demographics
NPI:1871038794
Name:BLUE LOTUS THERAPEUTIC SERVICES, PC
Entity type:Organization
Organization Name:BLUE LOTUS THERAPEUTIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-528-3505
Mailing Address - Street 1:531 E A ST
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:531 E A ST
Practice Address - Street 2:SUITE 101B
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4102
Practice Address - Country:US
Practice Address - Phone:918-528-3505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-01
Last Update Date:2017-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4546101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty