Provider Demographics
NPI:1043029309
Name:LOTUS SPACE LLC
Entity type:Organization
Organization Name:LOTUS SPACE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE & FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:AMFT
Authorized Official - Phone:215-203-6146
Mailing Address - Street 1:239 4TH AVE STE 1401
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15222-1715
Mailing Address - Country:US
Mailing Address - Phone:215-839-6096
Mailing Address - Fax:
Practice Address - Street 1:6644 LOTUS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2344
Practice Address - Country:US
Practice Address - Phone:215-203-6146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty