Black Lotus Therapy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

BLACK LOTUS THERAPY

Practice address

10 Crater Lake Ave Ste 25
Medford, OR 97504-7445

Phone

(541) 500-8655

Fax

(800) 433-1396

NPI assigned

Jul 21, 2020

Organization subpart

No

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

Authorized official

Name

Tristin Victor, CSWA

Title

Owner

Phone

(541) 500-8655

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Tristin L Fouche

  • Clinical Social Worker
  • Ashland, OR
  • NPI 1861976953

  Mental Health

  NPD

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

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614816000000",
    "number": "1720696289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4752",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975010197",
            "telephone_number": "541-500-8655",
            "fax_number": "800-433-1396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CRATER LAKE AVE STE 25",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975047445",
            "telephone_number": "541-500-8655",
            "fax_number": "800-433-1396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK LOTUS THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-21",
        "last_updated": "2021-03-04",
        "certification_date": "2021-03-04",
        "status": "A",
        "authorized_official_last_name": "VICTOR",
        "authorized_official_first_name": "TRISTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-500-8655",
        "authorized_official_credential": "CSWA"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Misty Bishop
• Susannah Bishop
• Margaret M. Bismarck, FNP
• Kimberly Bittner, CF-SLP
• Royce Allen Bivens, L.M.T.
• Amanda Black
• Leslie Black, PT
• Lori D Blake, PSS
• Judith Michelle Blakely
• Leanna Louise Blakely, QMHA2

• Mental Health Counselor in Medford, OR
• Providers in Medford, OR by specialty
• Mental Health Counselor in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.