Provider Demographics
NPI:1134546724
Name:SOUL SOLUTIONS, PLLC
Entity type:Organization
Organization Name:SOUL SOLUTIONS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC, NCC
Authorized Official - Phone:409-283-1974
Mailing Address - Street 1:6858 KINGSTON COVE LN
Mailing Address - Street 2:
Mailing Address - City:WILLIS
Mailing Address - State:TX
Mailing Address - Zip Code:77318-9121
Mailing Address - Country:US
Mailing Address - Phone:409-283-1974
Mailing Address - Fax:936-228-7994
Practice Address - Street 1:107 W MAIN
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:TX
Practice Address - Zip Code:75862-0000
Practice Address - Country:US
Practice Address - Phone:409-283-1974
Practice Address - Fax:936-228-7994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66084251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2303810OtherCOMPSYCH
TX323797601Medicaid
TX12618131OtherCAQH ID
TX323797602Medicaid
TX9203LLOtherBLUE CROSS BLUE CHIELD OF TX