Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Black Lotus Therapy

Organization Mental Health Counselor · NPI 1720696289

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 25
Medford, OR 97504-7445
Phone: (541) 500-8655
Fax: (800) 433-1396
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Mental Health Counselor (primary) Taxonomy 101YM0800X

Record details

NPI number1720696289
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tristin Victor — Owner · (541) 500-8655
NPI enumeratedJuly 21, 2020
Last updated in NPPESMarch 4, 2021
Certification dateMarch 4, 2021
Mailing addressPo Box 4752, Medford, OR 97501-0197

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