MEDICARE: DESTINY A SOULT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1609663517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESTINY A SOULT

Provider Business Mailing Address
First Line	:	2400 SPENARD RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-1644
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 SPENARD RD STE 200
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-1644
Country	:	US
Telephone Number	:	907-444-7297
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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Directions to “ DESTINY A SOULT ” Practice Location

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