Provider Demographics
NPI:1205522331
Name:HEART & SOUL WELLNESS
Entity type:Organization
Organization Name:HEART & SOUL WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:HOWLETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-414-5065
Mailing Address - Street 1:189 S STATE ST STE 222
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-1061
Mailing Address - Country:US
Mailing Address - Phone:801-414-5065
Mailing Address - Fax:
Practice Address - Street 1:189 S STATE ST STE 222
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-1061
Practice Address - Country:US
Practice Address - Phone:801-414-5065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health