SOUL GROWTH LLC (NPI# 1417469115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417469115 |
| Entity Type | Organization |
| Organization Name | SOUL GROWTH LLC |
| Practice Address |
1719 S Main St Salt Lake City UT 84115-1911 |
| Mailing Address |
2011 S 2100 E Apt 306 Salt Lake City UT 84108-3176 |
| Practice Telephone | 3073898044 |
| Mailing Telephone | 3073898044 |
| Enumeration Date | 2017-11-02 |
| Last Update Date | 2017-11-14 |
| Authorized Official Name | MRS. JESSICA L VASA (MENTAL HEALTH CLINICIAN) |
| Authorized Official Telephone | 3073898044 |
| Authorized Official Credential | LCSW |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
10492016-3501 | UT | Ambulatory Health Care Facilities |
| Street Address |
1719 S MAIN ST |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84115-1911 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962898387 | Full Circle Yoga and Therapy Pllc | Community/Behavioral Health | 1719 S Main St, Salt Lake City, UT 84115-1911 | 2015-04-13 |
| 1700383502 | Ally Counseling, LLC | Social Worker | 1719 S Main St, Salt Lake City, UT 84115-1911 | 2018-04-09 |
| 1811347446 | Candace Curzon | Social Worker | 1719 S Main St, Salt Lake City, UT 84115-1911 | 2016-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396344198 | Shannon Ballinger | Clinic/Center | 1470 400 W, Salt Lake City, UT 84115 | 2020-10-22 |
| 1992346704 | Anicka Inc | Clinic/Center | 3195 South Main St, Ste 260, South Salt Lake, UT 84115 | 2019-10-02 |
| 1083177505 | Vitor Gabriel Giuliani Alcantara Carioca | Specialist/Technologist | 1850 South Campus Drive, Salt Lake City, UT 84115 | 2019-04-11 |
| 1427528371 | Samuel James Leonhart | Behavior Technician | 354 East Coatsville Drive, Salt Lake City, UT 84115 | 2018-12-04 |
| 1093228645 | Eco Pharmacy LLC | Pharmacy | 3702 S State Street Suite 115, South Salt Lake City, UT 84115 | 2017-11-06 |
| 1568973055 | Eco Apothecary LLC | Pharmacy | 3701 S State Street Suite 114, South Salt Lake City, UT 84115 | 2017-10-24 |
| 1548780455 | Kelly Lund | Case Manager/Care Coordinator | 447 W. Bearcat Dr., Salt Lake City, UT 84115 | 2017-06-21 |
| 1104271238 | The Church of Philadelphia Inc. | Community/Behavioral Health | 2358 South Main Street, Salt Lake City, UT 84115 | 2016-04-26 |
| 1710368626 | Jennifer Swanhild Edwards | Counselor | 140 W 2100 S Ste 244, Salt Lake City, UT 84115 | 2015-06-16 |
| 1508247065 | John Mcguire | Health Educator | 1370 S. West Temple, Salt Lake City, UT 84115 | 2015-06-10 |
| Find all providers in zip 84115 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790269892 | Center for Healing Therapies | Clinic/Center | 699 N. S. Temple, Suite 201 G, Salt Lake City, UT 84102-4252 | 2018-09-24 |
| 1730661349 | City Center Psychology, Pllc | Clinic/Center | 175 S Main St Ste 530, Salt Lake City, UT 84111-1916 | 2018-08-30 |
| 1649684903 | Child and Family Empowerment Services, LLC | Clinic/Center | 1578 W 1700 S Ste 200, Salt Lake City, UT 84104-3461 | 2014-06-16 |
| 1215215181 | Stein Mann Institute, LLC | Clinic/Center | 10 W Broadway Ste 820, Salt Lake City, UT 84101-2000 | 2011-07-26 |
| 1326159948 | Front Line Services, Inc. | Clinic/Center | 1800 S West Temple, Suite A110, Salt Lake City, UT 84115-1851 | 2006-08-31 |
| 1548239940 | Center for Human Potential Inc | Clinic/Center | 525 E 100 S, Suite 120, Salt Lake City, UT 84102-2070 | 2006-03-16 |
| 1285261016 | Tava Health, Inc | Clinic/Center | 222 E 7th Ave, Salt Lake City, UT 84103-2518 | 2020-03-23 |
| 1952883589 | Susan Curtis, Cmhc, PC | Clinic/Center | 1390 S 1100 E Ste 203, Salt Lake City, UT 84105 | 2018-08-30 |
| 1518466465 | Salt Lake Counseling and Coaching, Pllc | Clinic/Center | 1516 S 1100 E, Salt Lake City, UT 84105-2425 | 2018-02-06 |
| 1255859740 | Survive & Thrive Therapy Services, Pllc | Clinic/Center | 4190 S Highland Dr Ste 115, Salt Lake City, UT 84124-2668 | 2017-09-05 |
| Find all providers in SALT LAKE CITY | ||||
| City | SALT LAKE CITY |
| Zip Code | 84115 |
Please comment or provide details below to improve the information on SOUL GROWTH LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.