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General NPI Number Information
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NPI Number | 1649728932
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Entity Type | Organization
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Legal Business Name | MY SOUL ELEMENTS LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 21 N LAST CHANCE GULCH #107
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City | HELENA
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State | MT
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Zip | 59601-4137
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Country | US
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Telephone | 406-860-0660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1406
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City | HELENA
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State | MT
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Zip | 59624-1406
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Country | US
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Telephone | 406-860-0660
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Fax |
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Authorized Official
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Title or Position | LCSW/OWNER
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Name | KOBI S SCHAFF
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Credential |
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Telephone | 406-860-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 18702
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License Number State | MT
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