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General NPI Number Information
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NPI Number | 1326726092
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Entity Type | Organization
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Legal Business Name | SOMA SPIRIT THERAPEUTICS LLC
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Dates
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Enumeration Date | 07/11/2023
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 507 S 4TH ST STE B
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City | LARAMIE
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State | WY
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Zip | 82070-3753
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Country | US
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Telephone | 307-760-4775
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Fax |
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Provider Business Mailing Address
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Address Line | 507 S 4TH ST STE B
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City | LARAMIE
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State | WY
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Zip | 82070-3753
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Country | US
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Telephone | 307-760-4775
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. STEPHANIE JOYCE HANSON
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Credential | MS, LPC
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Telephone | 307-760-4775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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