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General NPI Number Information
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NPI Number | 1700551447
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Entity Type | Organization
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Legal Business Name | SOULFULLY URS, LLC
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Dates
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Enumeration Date | 08/13/2021
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 9898 BISSONNET ST STE 470
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City | HOUSTON
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State | TX
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Zip | 77036-8280
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Country | US
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Telephone | 281-888-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 WOODVALE DR UNIT B
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City | MISSOURI CITY
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State | TX
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Zip | 77489-1421
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Country | US
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Telephone | 281-901-9412
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TERESA ANTOINETTE FULLER
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Credential | LCSW, LCDC
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Telephone | 206-578-1207
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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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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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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