Provider Demographics
NPI:1437932241
Name:SOUL AWAKENING LLC
Entity Type:Organization
Organization Name:SOUL AWAKENING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LIMHP, LADC
Authorized Official - Phone:402-805-1099
Mailing Address - Street 1:2311 S 36TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-6626
Mailing Address - Country:US
Mailing Address - Phone:402-805-1099
Mailing Address - Fax:
Practice Address - Street 1:4910 NORMAL BLVD STE D
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-6300
Practice Address - Country:US
Practice Address - Phone:531-500-4271
Practice Address - Fax:531-500-5447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty