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BLACK LOTUS THERAPY
NPI 1720696289
Counselor - Mental Health in Medford, OR

Active since July 21, 2020
10 CRATER LAKE AVE STE 25, MEDFORD, OR 97504(541) 500-8655(800) 433-1396 Get Directions Write a Review

NPPES record last updated: March 4, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 4, 2021, Nov 21, 2020, Jul 21, 2020 (3 updates tracked since 2020).

About Black Lotus Therapy NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BLACK LOTUS THERAPY (NPI 1720696289) is a healthcare organization registered as a mental health in Medford, Oregon and active in the NPI registry since July 2020. The organization lists Tristin Victor, Owner, as its authorized official.

NPPES Registry Identity

NPI1720696289
Entity TypeOrganization
Primary Taxonomy101YM0800X
Legal Business NameBLACK LOTUS THERAPY
Location Address10 CRATER LAKE AVE STE 25Medford, OR 97504-7445
Mailing AddressPo Box 4752Medford, OR 97501-0197 · (541) 500-8655 · Fax (800) 433-1396
Phone(541) 500-8655
Fax(800) 433-1396
Organization SubpartNo
Authorized OfficialTristin VictorOwner · (541) 500-8655
Enumeration DateJuly 21, 2020
Last NPPES UpdateMarch 4, 20213 updates tracked since enumeration
NPPES CertifiedMarch 4, 2021
✔ NPI 1720696289 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
10 CRATER LAKE AVE STE 25, Medford, OR 97504
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Black Lotus Therapy's NPI number?

The NPI number for Black Lotus Therapy is 1720696289. It was assigned to this organization in the NPPES registry on July 21, 2020.

Where is Black Lotus Therapy located?

Black Lotus Therapy is located at 10 Crater Lake Ave Ste 25, Medford, OR 97504. The listed phone number is (541) 500-8655.

What is Black Lotus Therapy's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

When was this NPI record last updated?

The NPPES record for Black Lotus Therapy was last updated on March 4, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.