Healthcare Provider Details

I. General information

NPI: 1871227645
Provider Name (Legal Business Name): SOUL PSYCHIATRY -FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 N NOVA RD STE 203
ORMOND BEACH FL
32174-4422
US

IV. Provider business mailing address

533 N NOVA RD STE 203
ORMOND BEACH FL
32174-4422
US

V. Phone/Fax

Practice location:
  • Phone: 386-672-7175
  • Fax: 386-672-0771
Mailing address:
  • Phone: 386-672-7175
  • Fax: 386-672-0771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ARTHUR BROUSE
Title or Position: PRESIDENT
Credential: APRN-PMHNP
Phone: 801-369-4544