Organization
GREEN LOTUS PSYCHOTHERAPY & CONSULTING, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODY BANTZ PSY.D. (PRESIDENT/CLINICAL PSYCHOLOGIST)
(858) 344-2668
Entity
Organization
Contact information
Practice address
10455 POMERADO RD, SAN DIEGO, CA 92131
(858) 344-2668
(760) 262-3026
Mailing address
PO BOX 2253, RANCHO MIRAGE, CA 92270-1085
(858) 344-2668
(760) 262-3026
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY20351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1295773232
NPI-INDIVIDUAL
—
Enumeration date
04/15/2014
Last updated
02/07/2024
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