Healthcare Provider Details

I. General information

NPI: 1366363244
Provider Name (Legal Business Name): SOULFUL SAGE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 N 100 E STE 8
ST GEORGE UT
84770-2505
US

IV. Provider business mailing address

369 N 2480 W
HURRICANE UT
84737-3511
US

V. Phone/Fax

Practice location:
  • Phone: 801-661-4388
  • Fax:
Mailing address:
  • Phone: 801-661-4388
  • 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: SHELBIE BOUCK
Title or Position: OWNER
Credential: LCMHC
Phone: 801-661-4388