Black Lotus Therapy
Black Lotus Therapy is a Mental Health Counselor in Medford, Oregon. Registered with an NPI since 2020.
- In the registry since
- 2020
Practice location Address checks out
10 Crater Lake Ave Ste 25Medford, OR 97504-7445
Phone: (541) 500-8655
Fax: (800) 433-1396
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Mental Health Counselor (primary) | Taxonomy 101YM0800X |
|---|
Record details
| NPI number | 1720696289 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Tristin Victor — Owner · (541) 500-8655 |
| NPI enumerated | July 21, 2020 |
| Last updated in NPPES | March 4, 2021 |
| Certification date | March 4, 2021 |
| Mailing address | Po Box 4752, Medford, OR 97501-0197 |
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