| Green Lotus Psychotherapy & Consulting, Inc. | |
|
10455 Pomerado Rd San Diego CA 92131 | |
| (858) 344-2668 | |
| (760) 262-3026 |
| Full Name | Green Lotus Psychotherapy & Consulting, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 10455 Pomerado Rd, San Diego, California |
| Authorized Official Name and Position | Jody Bantz (PRESIDENT/CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8583442668 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Green Lotus Psychotherapy & Consulting, Inc. Po Box 2253 Rancho Mirage CA 92270-1085 Ph: (858) 344-2668 | Green Lotus Psychotherapy & Consulting, Inc. 10455 Pomerado Rd San Diego CA 92131 Ph: (858) 344-2668 |
| NPI Number | 1427477751 |
|---|---|
| Provider Enumeration Date | 04/15/2014 |
| Last Update Date | 02/07/2024 |
| Certification Date | 02/02/2024 |
| Medicare PECOS PAC ID | 1951533454 |
|---|---|
| Medicare Enrollment ID | O20140416000818 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427477751 | NPI | - | NPPES |
| 1295773232 | Other | NPI-INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | PSY20351 (California) | Primary |
| Provider Name | Jody L Bantz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1295773232 PECOS PAC ID: 4385658954 Enrollment ID: I20060202000754 |
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