Provider Demographics
NPI:1639956618
Name:SOUL YOGA PHILLY
Entity Type:Organization
Organization Name:SOUL YOGA PHILLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC
Authorized Official - Phone:267-270-2407
Mailing Address - Street 1:1647 THE FAIRWAY # 1302
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-1423
Mailing Address - Country:US
Mailing Address - Phone:267-270-2407
Mailing Address - Fax:
Practice Address - Street 1:1647 THE FAIRWAY # 1302
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1423
Practice Address - Country:US
Practice Address - Phone:267-270-2407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty