Healthcare Provider Details

I. General information

NPI: 1134789993
Provider Name (Legal Business Name): SOUL FEATHER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 CLARE AVE STE 5
WEST PALM BEACH FL
33401-6219
US

IV. Provider business mailing address

340 ALMERIA RD APT 1
WEST PALM BEACH FL
33405-1247
US

V. Phone/Fax

Practice location:
  • Phone: 561-779-1575
  • Fax:
Mailing address:
  • Phone: 561-779-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA M MOSSING
Title or Position: SOCIAL WORKER/THERAPIST/OWNER
Credential: LCSW, CAP, RYT
Phone: 561-779-1575