Provider Demographics
NPI:1255703823
Name:THE SOUL CARE HOUSE
Entity type:Organization
Organization Name:THE SOUL CARE HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPY INTERN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:LIMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-690-8021
Mailing Address - Street 1:1427 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-1711
Mailing Address - Country:US
Mailing Address - Phone:602-690-8021
Mailing Address - Fax:
Practice Address - Street 1:1427 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1711
Practice Address - Country:US
Practice Address - Phone:602-690-8021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF87455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty