=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902768815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOAR PROFESSIONAL COUNSELING SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2025
-----------------------------------------------------
Last Update Date | 11/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8033 W MINNEZONA AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85033-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-492-5176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8033 W MINNEZONA AVE
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85033-2241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL THERAPIST/SUPERVISOR
-----------------------------------------------------
Name | TERRANCE SOUTHERN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 602-492-5176
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------