MEDICARE: SOUL FIRE WELLNESS 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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1982413837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUL FIRE WELLNESS LLC

Provider Business Mailing Address
First Line	:	2555 WASHINGTON RD STE 610A
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-2574
Country	:	US
Telephone Number	:	412-212-3654
Fax Number	:

Provider Business Practice Location Address
First Line	:	2555 WASHINGTON RD STE 610A
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15241-2574
Country	:	US
Telephone Number	:	412-212-3654
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LAUREN JANELLE BRUNNER
Credential	:	LCSW
Telephone Number	:	412-212-3654

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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Directions to “SOUL FIRE WELLNESS LLC ” Practice Location

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