Healthcare Provider Details

I. General information

NPI: 1679494660
Provider Name (Legal Business Name): SOUL 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

950 PACIFIC AVE STE 205
TACOMA WA
98402-4400
US

IV. Provider business mailing address

13516 MERIDIAN E UNIT 73123
PUYALLUP WA
98373-9947
US

V. Phone/Fax

Practice location:
  • Phone: 253-229-9613
  • Fax:
Mailing address:
  • Phone: 253-229-9613
  • Fax: 253-229-9613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MARZELLA J HARRIS
Title or Position: MANAGING MEMBER
Credential: MA
Phone: 253-229-9613