Provider Demographics
NPI:1891501250
Name:THE LOTUS CENTER FOR NEURODIVERSITY
Entity type:Organization
Organization Name:THE LOTUS CENTER FOR NEURODIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROFESSIONAL COUNSELOR ASSOC
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PCA, CAS
Authorized Official - Phone:503-470-1743
Mailing Address - Street 1:80145 POLO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:OR
Mailing Address - Zip Code:97146-9013
Mailing Address - Country:US
Mailing Address - Phone:503-730-8589
Mailing Address - Fax:
Practice Address - Street 1:2793 HIGHWAY 101 N STE 24
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4349
Practice Address - Country:US
Practice Address - Phone:971-286-8275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty