Blue Lotus Connection

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

BLUE LOTUS CONNECTION

Practice address

1700 S Amphlett Blvd, Ste 250B
San Mateo, CA 94402

Phone

(650) 619-9942

NPI assigned

Dec 11, 2017

Organization subpart

No

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

Authorized official

Name

Patrice Fortune, MA, MS, LMFT, ATRNPI 1235368135

Title

Founder/Owner

Phone

(650) 619-9942

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Patrice Fortune, PHD

  • Marriage & Family Therapist
  • San Mateo, CA
  • NPI 1235368135
  NPD (past) Authorized official

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

{
    "created_epoch": "1512950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512950400000",
    "number": "1760997902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 BOVET ROAD #221",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94402",
            "telephone_number": "650-619-9942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 S AMPHLETT BLVD, STE 250B",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "94402",
            "telephone_number": "650-619-9942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE LOTUS CONNECTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-11",
        "last_updated": "2017-12-11",
        "status": "A",
        "authorized_official_last_name": "FORTUNE",
        "authorized_official_first_name": "PATRICE",
        "authorized_official_title_or_position": "FOUNDER/OWNER",
        "authorized_official_telephone_number": "650-619-9942",
        "authorized_official_credential": "MA, MS, LMFT, ATR"
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235368135",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Catrina Patricia Blake, FNP
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• Shawntal Renee Blevins
• Jessica Blois, M.A.
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• Julia Bohm, LCSW
• Kenzie Bohnsack

• Point of Service in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Point of Service in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2017; 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.