NPIMap

Organization Active NPI

Lotus Behavioral Health LLC

  • Clinical Psychologist
  • Tukwila, WA
National Provider Identifier
1891095410
Registry record updated Aug 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY3514 Issued in WA
Legal business name
LOTUS BEHAVIORAL HEALTH LLC
Practice address
16040 Christensen Rd
Suite 209
Tukwila, WA 98188-2934
Phone
(206) 328-8889
Fax
(206) 328-8884
NPI assigned
Oct 29, 2010
Last updated
Aug 21, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2011

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

Authorized official

Name
Dr. Theresa Lock, PH.D.NPI 1659550671
Title
Executive Director
Phone
(206) 328-8889

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY3514 WA Primary
Clinical Social Worker 1041C0700X LW00009478 WA

Addresses

Primary practice location

16040 Christensen Rd
Suite 209
Tukwila, WA 98188-2934

Mailing address

PO Box 84625
Seattle, WA 98124-5925
Phone (206) 328-8889

Other identifiers 1

IdentifierTypeStateIssuer
2012099MedicaidWA

National Provider Directory

National Provider Directory

Locations

16040 Christensen Rd
Ste 209
Tukwila, WA 98188
Phone (206) 328-8889

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1288310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313884800000",
    "number": "1891095410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 84625",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245925",
            "telephone_number": "206-328-8889",
            "fax_number": "206-328-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16040 CHRISTENSEN RD",
            "address_2": "SUITE 209",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882934",
            "telephone_number": "206-328-8889",
            "fax_number": "206-328-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOTUS BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-29",
        "last_updated": "2011-08-21",
        "status": "A",
        "authorized_official_last_name": "LOCK",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "206-328-8889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY3514",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW00009478",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012099",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tukwila, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2011; 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.