MEDICARE: SOUL CONNECTION 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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1861328171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL CONNECTION THERAPY

Provider Business Mailing Address
First Line	:	1330 SHELBY DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-4345
Country	:	US
Telephone Number	:	408-849-2669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 SHELBY DR
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94534-4345
Country	:	US
Telephone Number	:	408-849-2669
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	FABIANA VEGA
Credential	:	LMFT
Telephone Number	:	408-849-2669

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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Directions to “SOUL CONNECTION THERAPY ” Practice Location

Language	Start Address	Practice Location

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