Provider Demographics
NPI:1174159875
Name:LOTUS RISING HOLISTIC THERAPY CENTER
Entity type:Organization
Organization Name:LOTUS RISING HOLISTIC THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:BEDELL
Authorized Official - Last Name:MANENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:619-887-3522
Mailing Address - Street 1:2386 FARADAY AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-7222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2386 FARADAY AVE STE 140
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7222
Practice Address - Country:US
Practice Address - Phone:760-496-9394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty