Healthcare Provider Details

I. General information

NPI: 1053964312
Provider Name (Legal Business Name): SOUL RESTORATIONS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 S CLEARWATER LOOP STE 8049
POST FALLS ID
83854-9599
US

IV. Provider business mailing address

784 S CLEARWATER LOOP STE 8049
POST FALLS ID
83854-9599
US

V. Phone/Fax

Practice location:
  • Phone: 206-317-1200
  • Fax: 206-316-8399
Mailing address:
  • Phone: 206-317-1200
  • Fax: 206-316-8399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA J PIERCE
Title or Position: MENTAL HEALTH THERAPIST
Credential: MA, LMHC, LCPC
Phone: 206-317-1200