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General NPI Number Information
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NPI Number | 1558180372
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Entity Type | Organization
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Legal Business Name | SOULMINE LLC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 1121 N. 5TH STREET SUITE 109
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City | KANSAS CITY
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State | KS
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Zip | 66101
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Country | US
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Telephone | 913-303-9868
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 N. 5TH STREET SUITE 109
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City | KANSAS CITY
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State | KS
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Zip | 66101
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Country | US
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Telephone | 913-303-9868
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Fax |
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Authorized Official
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Title or Position | CEO / HEAD THERAPIST & FACILITATOR
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Name | MS. CHANDRA GREEN
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Credential | LMFT
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Telephone | 913-303-9868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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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 | 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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