MEDICARE: SOUL CARE COUNSELING, LLC

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)	314	KS

General Provider Information

NPI Number	:	1689816100
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL CARE COUNSELING, LLC

Provider Business Mailing Address
First Line	:	12165 PARALLEL PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4536
Country	:	US
Telephone Number	:	913-515-6919
Fax Number	:	913-721-2154

Provider Business Practice Location Address
First Line	:	12165 PARALLEL PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-4536
Country	:	US
Telephone Number	:	913-515-6919
Fax Number	:	913-721-2154

Authorized Official
Title or Position	:	CEO
Name	:	BARBARA CLEVERDON
Credential	:	LCMFT
Telephone Number	:	913-515-6919

Provider Enumeration Date	:	03/30/2009
Last Update Date	:	03/30/2009

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