Healthcare Provider Details

I. General information

NPI: 1851263305
Provider Name (Legal Business Name): SOUL EXPLICIT COUNSELING & AUTHENTIC INTELLIGENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1538 CERRO GORDO RD APT 1
SANTA FE NM
87501-6263
US

IV. Provider business mailing address

1538 CERRO GORDO RD # 1
SANTA FE NM
87501-6263
US

V. Phone/Fax

Practice location:
  • Phone: 505-316-8474
  • Fax:
Mailing address:
  • Phone: 505-316-8474
  • 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: MS. KATHERINE GOTIS
Title or Position: OWNER
Credential: LPCC
Phone: 505-316-8474