Provider Demographics
NPI:1063071835
Name:LOTUS MOON COUNSELING, LLC
Entity type:Organization
Organization Name:LOTUS MOON COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, MGMR
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POST
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:904-717-5445
Mailing Address - Street 1:3955 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-3312
Mailing Address - Country:US
Mailing Address - Phone:904-717-5445
Mailing Address - Fax:
Practice Address - Street 1:3955 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-3312
Practice Address - Country:US
Practice Address - Phone:904-717-5445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)