Provider Demographics
NPI:1386340958
Name:WHITE LOTUS INSTITUTE, PLLC
Entity type:Organization
Organization Name:WHITE LOTUS INSTITUTE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-997-0438
Mailing Address - Street 1:2217 S CHESTNUT CIR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-5124
Mailing Address - Country:US
Mailing Address - Phone:801-633-3119
Mailing Address - Fax:
Practice Address - Street 1:2217 S CHESTNUT CIR
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-5124
Practice Address - Country:US
Practice Address - Phone:801-633-3119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty