Healthcare Provider Details

I. General information

NPI: 1255144473
Provider Name (Legal Business Name): SOL 2 SOUL HEALING CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 TABLE ROCK RD
COPPERAS COVE TX
76522-7133
US

IV. Provider business mailing address

4111 TABLE ROCK RD
COPPERAS COVE TX
76522-7133
US

V. Phone/Fax

Practice location:
  • Phone: 254-307-2320
  • Fax:
Mailing address:
  • Phone: 254-987-5080
  • Fax: 254-987-5040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ERICA LUGENE BOUCHER
Title or Position: OWNER/ CHIEF OPERATING OFFICER
Credential:
Phone: 254-987-5080