Healthcare Provider Details

I. General information

NPI: 1356277388
Provider Name (Legal Business Name): MYSTIC SOUL COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6102 W 177TH AVE
LOWELL IN
46356-1900
US

IV. Provider business mailing address

6102 W 177TH AVE
LOWELL IN
46356-1900
US

V. Phone/Fax

Practice location:
  • Phone: 219-689-2062
  • Fax: 219-689-2062
Mailing address:
  • Phone: 219-689-2062
  • Fax: 219-689-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE LYNN EICH
Title or Position: LICENSED MENTAL HEALTH COUNSELOR
Credential: LMHC
Phone: 219-689-2062