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General NPI Number Information
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NPI Number | 1437932241
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Entity Type | Organization
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Legal Business Name | SOUL AWAKENING LLC
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Dates
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Enumeration Date | 08/15/2023
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Last Update Date | 04/25/2024
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Provider Practice Location Address
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Address Line | 4910 NORMAL BLVD STE D
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City | LINCOLN
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State | NE
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Zip | 68506-6300
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Country | US
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Telephone | 531-500-4271
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Fax | 531-500-5447
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Provider Business Mailing Address
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Address Line | 2311 S 36TH ST
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City | LINCOLN
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State | NE
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Zip | 68506-6626
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Country | US
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Telephone | 402-805-1099
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Fax |
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Authorized Official
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Title or Position | THERAPIST AND CEO
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Name | MELISSA THORNE
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Credential | MA, LIMHP, LADC
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Telephone | 402-805-1099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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