MEDICARE: VIBRANT SOUL COUNSELING & CONSULTING PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor
3	171400000X	Health & Wellness Coach
4	225800000X	Recreation Therapist
5	226000000X	Recreational Therapist Assistant
6	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1992473425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT SOUL COUNSELING & CONSULTING PLLC

Provider Business Mailing Address
First Line	:	1018 MARGATE CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-2301
Country	:	US
Telephone Number	:	281-685-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 MARGATE CT
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-2301
Country	:	US
Telephone Number	:	281-685-2503
Fax Number	:

Authorized Official
Title or Position	:	OWNER, LEAD CLINICIAN
Name	:	MRS. ANGELA NICHOLE TAYLOR
Credential	:	MS, LPC
Telephone Number	:	281-685-2503

Provider Enumeration Date	:	08/31/2021
Last Update Date	:	08/31/2021

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