Provider Demographics
NPI:1043769359
Name:SPIRITS HEALING SOULS LLC
Entity Type:Organization
Organization Name:SPIRITS HEALING SOULS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-641-4403
Mailing Address - Street 1:1880 SE COLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-9109
Mailing Address - Country:US
Mailing Address - Phone:316-641-4403
Mailing Address - Fax:
Practice Address - Street 1:1880 SE COLE CREEK RD
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-9109
Practice Address - Country:US
Practice Address - Phone:316-641-4403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS172V00000XOtherCOMMUNITY MENTAL HEALTH CENTER
KS171000000XOtherCOMMUNITY MENTAL HEALTH CENTER