Green Lotus Psychotherapy & Consulting, Inc.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY20351 Issued in CA

Legal business name

GREEN LOTUS PSYCHOTHERAPY & CONSULTING, INC.

Practice address

10455 Pomerado Rd
San Diego, CA 92131

Phone

(858) 344-2668

Fax

(760) 262-3026

NPI assigned

Apr 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jody Bantz, PSY.D.NPI 1295773232

Title

President/Clinical Psychologist

Phone

(858) 344-2668

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jody Bantz

  • Clinical Psychologist
  • Rancho Mirage, CA
  • NPI 1295773232
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1427477751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2253",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701085",
            "telephone_number": "858-344-2668",
            "fax_number": "760-262-3026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10455 POMERADO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92131",
            "telephone_number": "858-344-2668",
            "fax_number": "760-262-3026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN LOTUS PSYCHOTHERAPY & CONSULTING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-02",
        "status": "A",
        "authorized_official_last_name": "BANTZ",
        "authorized_official_first_name": "JODY",
        "authorized_official_title_or_position": "PRESIDENT/CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "858-344-2668",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY20351",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI-INDIVIDUAL",
            "identifier": "1295773232",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sophia Greco, PT, DPT
• Quynh-Nga Bui Gredig, RN, MPH, MS
• Channing Gredvig, LCSW
• Briana Greeley
• Green Flash Physician Oversight PC
• Green Pastures Doula LLC
• Green Room Psychology Services Incorporation
• Green Waves Psychiatry Nursing Inc
• Johanna Green-Jacob, NURSE PRACTITIONER
• Acacia Marie Green

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.