| Lotus Center Inc | |
|
348 E 4500 S Suite 360 Salt Lake City UT 84107-3906 | |
| (385) 272-4292 | |
| (866) 855-3582 |
| Full Name | Lotus Center Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 348 E 4500 S, Salt Lake City, Utah |
| Authorized Official Name and Position | Cindy Butters (APRN) |
| Authorized Official Contact | 8018242185 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lotus Center Inc 2204 E 3715 S Salt Lake City UT 84109-3338 Ph: (801) 824-2185 | Lotus Center Inc 348 E 4500 S Suite 360 Salt Lake City UT 84107-3906 Ph: (385) 272-4292 |
| NPI Number | 1992167118 |
|---|---|
| Provider Enumeration Date | 03/26/2016 |
| Last Update Date | 07/25/2016 |
| Medicare PECOS PAC ID | 4284923491 |
|---|---|
| Medicare Enrollment ID | O20160511001262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992167118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2001474405 (Utah) | Primary |
| Provider Name | Peggy Anne Jerome |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013001247 PECOS PAC ID: 9234169764 Enrollment ID: I20050819000230 |
| Provider Name | Cynthia Wasek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952398737 PECOS PAC ID: 9133134901 Enrollment ID: I20060221000166 |
| Provider Name | Charles J Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972896702 PECOS PAC ID: 9032431895 Enrollment ID: I20141205000006 |
| Provider Name | Randi Hollis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346642121 PECOS PAC ID: 2769707256 Enrollment ID: I20150204000008 |
| Provider Name | Jennifer Oxborrow |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699041640 PECOS PAC ID: 4880988229 Enrollment ID: I20160809000431 |
| Provider Name | Shawn L Hazen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265719876 PECOS PAC ID: 4981991866 Enrollment ID: I20160920002135 |
| Provider Name | Sarah Elaine Kaihau |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497272025 PECOS PAC ID: 8325308414 Enrollment ID: I20180209002476 |
| Provider Name | Aubree Payne |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477046662 PECOS PAC ID: 9830446574 Enrollment ID: I20180725004017 |
| Provider Name | Lindsay Kaye Manning |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760779193 PECOS PAC ID: 4385998129 Enrollment ID: I20181114003326 |
| Provider Name | Eliot Sykes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528531761 PECOS PAC ID: 9830439934 Enrollment ID: I20190328000699 |
| Provider Name | Hannah Marie Zabka |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023571130 PECOS PAC ID: 4284967456 Enrollment ID: I20190604001576 |
| Provider Name | Nathaniel M Barusch |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1548648520 PECOS PAC ID: 3375879653 Enrollment ID: I20190724001587 |
| Provider Name | Tara L Bravo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457888125 PECOS PAC ID: 4789016460 Enrollment ID: I20191119000438 |
| Provider Name | Siqin Luo Simmons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578128443 PECOS PAC ID: 3870908213 Enrollment ID: I20210217003047 |
| Provider Name | Joshua Watkins |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952690083 PECOS PAC ID: 9638546443 Enrollment ID: I20221108002842 |
| Provider Name | David J Loden |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700226008 PECOS PAC ID: 6305084385 Enrollment ID: I20230717002568 |
| Provider Name | Gina Gammon Searle |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154390870 PECOS PAC ID: 1456704162 Enrollment ID: I20240130001107 |
| Provider Name | Kellie Leigh Terrell |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861790578 PECOS PAC ID: 0547613093 Enrollment ID: I20240131002755 |
| Provider Name | Amy D Feller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1962865121 PECOS PAC ID: 1153774609 Enrollment ID: I20240131002866 |
| Provider Name | D Patrick Mcguinness |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1124047006 PECOS PAC ID: 7315949682 Enrollment ID: I20240208003073 |
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