Provider Demographics
NPI:1134818115
Name:SOUNALATH, JEFFEY SOULIYA (LPC, LCDC, NCC)
Entity type:Individual
Prefix:MR
First Name:JEFFEY
Middle Name:SOULIYA
Last Name:SOUNALATH
Suffix:
Gender:M
Credentials:LPC, LCDC, NCC
Other - Prefix:MR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:SOUNALATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5301 DECKER LN APT 5303
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78724-5842
Mailing Address - Country:US
Mailing Address - Phone:515-418-6183
Mailing Address - Fax:
Practice Address - Street 1:5301 DECKER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78724-5814
Practice Address - Country:US
Practice Address - Phone:515-418-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15969101YA0400X
TX87077101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)