Healthcare Provider Details

I. General information

NPI: 1598605222
Provider Name (Legal Business Name): SACRED SOUL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 W EXPO PKWY APT M-203
POST FALLS ID
83854
US

IV. Provider business mailing address

5150 W EXPO PKWY APT M-203
POST FALLS ID
83815
US

V. Phone/Fax

Practice location:
  • Phone: 509-818-9964
  • Fax:
Mailing address:
  • Phone: 509-818-9964
  • Fax:

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: KRISTIN OPRIS
Title or Position: COUNSELOR
Credential: LCPC
Phone: 509-818-9964