Provider Demographics
NPI:1831833672
Name:BLACK LOTUS COUNSELING
Entity type:Organization
Organization Name:BLACK LOTUS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LCPC
Authorized Official - Phone:484-599-6420
Mailing Address - Street 1:1167 BERKSHIRE BLVD # 1033
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1244
Mailing Address - Country:US
Mailing Address - Phone:484-599-2640
Mailing Address - Fax:
Practice Address - Street 1:10 S LOS ROBLES CT
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-1535
Practice Address - Country:US
Practice Address - Phone:702-350-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty