| The Blue Lotus, Llc | |
|
225 W Cavour Ave Ste C Fergus Falls MN 56537-2140 | |
| (218) 770-0593 | |
| Not Available |
| Full Name | The Blue Lotus, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 225 W Cavour Ave Ste C, Fergus Falls, Minnesota |
| Authorized Official Name and Position | Christianne M Lysne (OWNER) |
| Authorized Official Contact | 2187700593 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Blue Lotus, Llc 31255 153rd Ave Elizabeth MN 56533-9562 Ph: (218) 770-0593 | The Blue Lotus, Llc 225 W Cavour Ave Ste C Fergus Falls MN 56537-2140 Ph: (218) 770-0593 |
| NPI Number | 1760944615 |
|---|---|
| Provider Enumeration Date | 04/01/2019 |
| Last Update Date | 04/01/2019 |
| Medicare PECOS PAC ID | 8729320775 |
|---|---|
| Medicare Enrollment ID | O20190424000091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760944615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Christianne M Lysne |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316158439 PECOS PAC ID: 4981704657 Enrollment ID: I20081203000930 |
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