Soul Growth LLC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Salt Lake City, UT. Organization (NPI-2).
NPI number1417469115
StatusActive
Last updated in NPPESNov 14, 2017
Details
- NPI
- 1417469115
- Entity type
- Organization (NPI-2)
- Legal business name
- Soul Growth LLC
- Organization subpart
- No
- Enumeration date
- Nov 2, 2017
- Last updated
- Nov 14, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | 10492016-3501 | UT | Yes |
Practice location
1719 S Main StSalt Lake City, UT 84115-1911
Phone 307-389-8044
Mailing address
2011 S 2100 E Apt 306Salt Lake City, UT 84108-3176
Phone 307-389-8044
Authorized official
Jessica L Vasa
Mental Health Clinician
3073898044
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