MEDICARE: SOMA PSYCHOTHERAPY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1659048247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOMA PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	6055 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-2503
Country	:	US
Telephone Number	:	520-873-8633
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 S HIGHLAND DR STE 220
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3759
Country	:	US
Telephone Number	:	520-873-8633
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KATHERINE KINCAID
Credential	:
Telephone Number	:	520-873-8633

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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Directions to “SOMA PSYCHOTHERAPY ” Practice Location

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