Provider Demographics
NPI:1801270186
Name:TEEGARDEN, LOTUS (MSW)
Entity type:Individual
Prefix:
First Name:LOTUS
Middle Name:
Last Name:TEEGARDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 NE BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1502
Mailing Address - Country:US
Mailing Address - Phone:971-415-6344
Mailing Address - Fax:503-388-3397
Practice Address - Street 1:1940 NE BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1502
Practice Address - Country:US
Practice Address - Phone:971-415-6344
Practice Address - Fax:503-388-3397
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
ORL118231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)