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General NPI Number Information
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NPI Number | 1588276380
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Entity Type | Organization
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Legal Business Name | SOUL.LY FAMILY COUNSELING
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Dates
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Enumeration Date | 08/21/2020
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Last Update Date | 08/21/2020
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Provider Practice Location Address
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Address Line | 602 STRADA CIR STE 119
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City | MANSFIELD
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State | TX
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Zip | 76063-3201
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Country | US
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Telephone | 469-712-6501
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Fax |
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Provider Business Mailing Address
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Address Line | 1118 COTTON SEED CIR
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City | WAXAHACHIE
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State | TX
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Zip | 75165-1614
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Country | US
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Telephone | 817-448-5854
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE G MCMILLAN
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Credential | LPC
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Telephone | 817-448-5854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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