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General NPI Number Information
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NPI Number | 1356277388
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Entity Type | Organization
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Legal Business Name | MYSTIC SOUL COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 06/18/2026
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Last Update Date | 06/18/2026
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Provider Practice Location Address
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Address Line | 6102 W 177TH AVE
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City | LOWELL
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State | IN
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Zip | 46356-1900
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Country | US
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Telephone | 219-689-2062
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Fax | 219-689-2062
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Provider Business Mailing Address
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Address Line | 6102 W 177TH AVE
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City | LOWELL
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State | IN
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Zip | 46356-1900
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Country | US
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Telephone | 219-689-2062
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Fax | 219-689-2062
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH COUNSELOR
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Name | KATHERINE LYNN EICH
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Credential | LMHC
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Telephone | 219-689-2062
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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