Organization
LOTUS BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THERESA LOCK PH.D. (EXECUTIVE DIRECTOR)
(206) 328-8889
Entity
Organization
Contact information
Practice address
16040 CHRISTENSEN RD, SUITE 209, TUKWILA, WA 98188-2934
(206) 328-8889
(206) 328-8884
Mailing address
PO BOX 84625, SEATTLE, WA 98124-5925
(206) 328-8889
(206) 328-8884
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY3514
WA
1041C0700X
Clinical Social Worker
LW00009478
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2012099
—
WA
Enumeration date
10/29/2010
Last updated
08/21/2011
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