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NPI Code Detail

MEDICARE: SOUL SPACE, LLC

MEDICARE: SOUL SPACE, 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
1251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871135335
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUL SPACE, LLC
Provider Business Mailing Address
First Line : 10501 E SEVEN GENERATIONS WAY STE 121
Second Line :
City : TUCSON
State : AZ
Zip : 85747-5828
Country : US
Telephone Number : 520-214-8650
Fax Number :
Provider Business Practice Location Address
First Line : 1580 N KOLB RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85715-4932
Country : US
Telephone Number : 520-214-8650
Fax Number :
Authorized Official
Title or Position : OWNER
Name : REBECCA HAMLIN
Credential : LCSW
Telephone Number : 520-214-8650
Provider Enumeration Date : 10/16/2019
Last Update Date : 07/10/2025

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Directions to “SOUL SPACE, LLC ” Practice Location

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