Healthcare Provider Details

I. General information

NPI: 1164135604
Provider Name (Legal Business Name): SOULFUL SOMATICS LICENSED CLINICAL SOCIAL WORKER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2022
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 GOVERNORS LN STE C
CHICO CA
95926-5514
US

IV. Provider business mailing address

4 GOVERNORS LN STE C
CHICO CA
95926-5514
US

V. Phone/Fax

Practice location:
  • Phone: 530-531-3459
  • Fax: 844-525-7544
Mailing address:
  • Phone: 530-531-3459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KRISRIN BROOKE FREE
Title or Position: CEO/OWNER
Credential: LCSW
Phone: 530-354-0455