MEDICARE: ATOMIC SOULS COUNSELING, PLLC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1851972079
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATOMIC SOULS COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	5401 FM 1626 STE 170-403
Second Line	:
City	:	KYLE
State	:	TX
Zip	:	78640-6038
Country	:	US
Telephone Number	:	512-553-2519
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 E 12TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78702-2141
Country	:	US
Telephone Number	:	512-553-2519
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RACHEL STEIN
Credential	:
Telephone Number	:	512-553-2519

Provider Enumeration Date	:	04/19/2021
Last Update Date	:	04/19/2021

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