Provider Demographics
NPI:1346645223
Name:SOUL JOURNEY THERAPY
Entity Type:Organization
Organization Name:SOUL JOURNEY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SUPRIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:802-451-6598
Mailing Address - Street 1:167 MAIN ST
Mailing Address - Street 2:BOX 17
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7128
Mailing Address - Country:US
Mailing Address - Phone:802-451-6598
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:SUITE 207E
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7128
Practice Address - Country:US
Practice Address - Phone:802-451-6598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.0094401041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty