MEDICARE: MENDED SOUL COUNSELING SERVICES, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194316265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MENDED SOUL COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	2601 LITTLE ELM PKWY STE 1704
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	972-565-6363
Fax Number	:	682-292-1350

Provider Business Practice Location Address
First Line	:	2601 LITTLE ELM PKWY STE 1704
Second Line	:
City	:	LITTLE ELM
State	:	TX
Zip	:	75068-2503
Country	:	US
Telephone Number	:	972-565-6363
Fax Number	:	682-292-1350

Authorized Official
Title or Position	:	OWNER/LEAD THERAPIST
Name	:	LINDSEY GRELA
Credential	:	LPC
Telephone Number	:	469-536-2849

Provider Enumeration Date	:	02/01/2021
Last Update Date	:	02/23/2025

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