MEDICARE: SOULFLO THERAPY

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	:	1841024213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOULFLO THERAPY

Provider Business Mailing Address
First Line	:	7521 EL PASO ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91942-4302
Country	:	US
Telephone Number	:	619-337-4176
Fax Number	:

Provider Business Practice Location Address
First Line	:	7290 NAVAJO RD STE 105
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92119-1631
Country	:	US
Telephone Number	:	619-356-6388
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	NANCY PHUNG-SMITH
Credential	:	MA, LMFT
Telephone Number	:	619-292-8885

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	09/15/2025

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Directions to “SOULFLO THERAPY ” Practice Location

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