Provider Demographics
NPI:1659269504
Name:DIVINE SOUL THERAPY LLC
Entity type:Organization
Organization Name:DIVINE SOUL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCC
Authorized Official - Phone:859-517-4633
Mailing Address - Street 1:1037 HINKSTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MOUNT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9301
Mailing Address - Country:US
Mailing Address - Phone:859-517-4633
Mailing Address - Fax:859-203-0843
Practice Address - Street 1:1099 INDIAN MOUND DR STE A
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1652
Practice Address - Country:US
Practice Address - Phone:859-517-4633
Practice Address - Fax:859-203-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-26
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty