Healthcare Provider Details

I. General information

NPI: 1326926296
Provider Name (Legal Business Name): SOUL GROUND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 FRENCH DR APT 4207
VALLEY PARK MO
63088-1628
US

IV. Provider business mailing address

950 FRENCH DR APT 4207
VALLEY PARK MO
63088-1628
US

V. Phone/Fax

Practice location:
  • Phone: 314-390-3256
  • Fax:
Mailing address:
  • Phone: 314-390-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: RIVER DOWDY
Title or Position: CLINICAL DIRECTOR
Credential: LPC
Phone: 314-328-5678