Healthcare Provider Details

I. General information

NPI: 1710769716
Provider Name (Legal Business Name): SOULSTICE MARRIAGE AND FAMILY THERAPY PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9891 IRVINE CENTER DR STE 200
IRVINE CA
92618-4320
US

IV. Provider business mailing address

9891 IRVINE CENTER DR STE 200
IRVINE CA
92618-4320
US

V. Phone/Fax

Practice location:
  • Phone: 310-853-3128
  • Fax:
Mailing address:
  • Phone: 310-853-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KEVIN YU
Title or Position: OWNER
Credential: LMFT
Phone: 312-270-1314