Healthcare Provider Details

I. General information

NPI: 1477210862
Provider Name (Legal Business Name): SOULMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2021
Last Update Date: 11/20/2021
Certification Date: 11/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 38TH ST STE 100
BOULDER CO
80301-2623
US

IV. Provider business mailing address

1650 38TH ST STE 100
BOULDER CO
80301-2623
US

V. Phone/Fax

Practice location:
  • Phone: 928-202-8173
  • Fax:
Mailing address:
  • Phone: 928-202-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DANA TSYCONYEA STARBYRD
Title or Position: FOUNDER
Credential: LMHC, LMT
Phone: 928-202-8173