MEDICARE: SOUL SONG COUNSELING, 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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1679057491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL SONG COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	1001 E BAYAUD AVE APT 1603
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80209-2385
Country	:	US
Telephone Number	:	303-929-4906
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 S CLARKSON ST STE 222
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-1627
Country	:	US
Telephone Number	:	303-929-4906
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	REBECCA HART
Credential	:	LPC
Telephone Number	:	303-929-4906

Provider Enumeration Date	:	09/18/2018
Last Update Date	:	09/18/2018

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