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General NPI Number Information
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NPI Number | 1215738026
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Entity Type | Organization
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Legal Business Name | SOULS LIFE WONC LLC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 1482 SINALOA RD
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City | SIMI VALLEY
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State | CA
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Zip | 93065-3031
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Country | US
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Telephone | 805-864-9046
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Fax |
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Provider Business Mailing Address
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Address Line | 1482 SINALOA RD
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City | SIMI VALLEY
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State | CA
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Zip | 93065-3031
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Country | US
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Telephone | 805-864-9046
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARYN N TARVER
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Credential |
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Telephone | 805-864-9046
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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