Provider Demographics
NPI:1417564568
Name:SACRED SOUL PSYCHOLOGY INC
Entity Type:Organization
Organization Name:SACRED SOUL PSYCHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:JOAN RAHIMA
Authorized Official - Last Name:SCHMALL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:707-318-4470
Mailing Address - Street 1:4362 VILLAGE LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-1833
Mailing Address - Country:US
Mailing Address - Phone:707-318-4470
Mailing Address - Fax:
Practice Address - Street 1:4362 VILLAGE LOOP
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-1833
Practice Address - Country:US
Practice Address - Phone:707-318-4470
Practice Address - Fax:707-637-8313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty