| Blue Lotus Therapy Services Llc | |
|
711 E Grand River Ave Brighton MI 48116-2474 | |
| (517) 896-3592 | |
| Not Available |
| Full Name | Blue Lotus Therapy Services Llc |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 711 E Grand River Ave, Brighton, Michigan |
| Authorized Official Name and Position | Mary Beth Houpt (CREDENTIALING) |
| Authorized Official Contact | 5176769797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blue Lotus Therapy Services Llc Po Box 10 Mason MI 48854-0010 Ph: () - | Blue Lotus Therapy Services Llc 711 E Grand River Ave Brighton MI 48116-2474 Ph: (517) 896-3592 |
| NPI Number | 1861051708 |
|---|---|
| Provider Enumeration Date | 06/12/2019 |
| Last Update Date | 12/19/2023 |
| Certification Date | 12/19/2023 |
| Medicare PECOS PAC ID | 2264884931 |
|---|---|
| Medicare Enrollment ID | O20240118000421 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861051708 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Gwenyth Marie Hayes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326416728 PECOS PAC ID: 1759730328 Enrollment ID: I20231207001896 |
| Provider Name | April L Pocalujka |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1700126182 PECOS PAC ID: 4880046556 Enrollment ID: I20240118000501 |
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