Healthcare Provider Details

I. General information

NPI: 1477475077
Provider Name (Legal Business Name): SOUL SUTRA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 W RAY RD STE 200
CHANDLER AZ
85226-2496
US

IV. Provider business mailing address

2115 E INDIAN WELLS DR
CHANDLER AZ
85249-4866
US

V. Phone/Fax

Practice location:
  • Phone: 520-449-4842
  • Fax:
Mailing address:
  • Phone: 520-449-4842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CALISTA HEATH-MARTINEZ
Title or Position: OWNER/THERAPIST
Credential: DBH, LCSW
Phone: 520-449-4842