Healthcare Provider Details

I. General information

NPI: 1831953645
Provider Name (Legal Business Name): SOUL CENTERED THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4959 OLSON MEMORIAL HWY STE B
GOLDEN VALLEY MN
55422-5159
US

IV. Provider business mailing address

4959 OLSON MEMORIAL HWY STE B
GOLDEN VALLEY MN
55422-5159
US

V. Phone/Fax

Practice location:
  • Phone: 612-242-6338
  • Fax:
Mailing address:
  • Phone: 612-242-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE LYNN CASEY
Title or Position: FOUNDER
Credential: LMFT
Phone: 612-242-6338