{"npi":"1427477751","type":"NPI-2","status":"active","name":{"display":"Green Lotus Psychotherapy & Consulting, Inc.","other":[],"organization_name":"GREEN LOTUS PSYCHOTHERAPY & CONSULTING, INC.","authorised_official":"Jody Bantz"},"specialty":{"primary_taxonomy":"103TC0700X","primary_taxonomy_description":"Clinical Psychologist","slug":"clinical-psychologist","schema_org_specialty":null,"all":[{"code":"103TC0700X","description":"Clinical Psychologist","primary":true,"state":"CA","license":"PSY20351"}]},"addresses":[{"purpose":"LOCATION","street_1":"10455 POMERADO RD","city":"SAN DIEGO","state":"CA","postal_code":"92131","country_code":"US","phone":"8583442668","fax":"7602623026"},{"purpose":"MAILING","street_1":"PO BOX 2253","city":"RANCHO MIRAGE","state":"CA","postal_code":"922701085","country_code":"US","phone":"8583442668","fax":"7602623026"}],"license":{"state":"CA","number":"PSY20351"},"identifiers":[{"type_code":"01","label":"Other","value":"1295773232","state":null,"issuer":"NPI-INDIVIDUAL"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20140416000818","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"CA","pac_id":"1951533454"}]},"enumeration_date":"2014-04-15","last_updated":"2024-02-07","_meta":{"source":"NPPES","snapshot_date":"2024-02-07","doc_url":"https://findmynpi.com/api"}}