MEDICARE: SOUL SOIL HEALING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM1300X	Multi-Specialty Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1356056782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SOIL HEALING LLC

Provider Business Mailing Address
First Line	:	3600 CLIPPER MILL RD STE 221
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-1946
Country	:	US
Telephone Number	:	442-320-2313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 CLIPPER MILL RD STE 221
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21211-1946
Country	:	US
Telephone Number	:	442-320-2313
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	DR. KRISTOPHER T GEBHARD
Credential	:	PHD
Telephone Number	:	218-280-2750

Provider Enumeration Date	:	01/19/2023
Last Update Date	:	03/25/2026

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Directions to “SOUL SOIL HEALING LLC ” Practice Location

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