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General NPI Number Information
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NPI Number | 1124635669
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Entity Type | Organization
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Legal Business Name | ULTIMATE SOUL PSYCH INC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 2598 E SUNRISE BLVD STE 2104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3230
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Country | US
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Telephone | 754-300-7001
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Fax |
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Provider Business Mailing Address
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Address Line | 2598 E SUNRISE BLVD STE 2104
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3230
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Country | US
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Telephone | 754-300-7001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PROF. GABRIELA ALESSANDRA SEGNINI
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Credential | LMHC
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Telephone | 954-624-6929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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