Provider Demographics
NPI:1265948863
Name:DEL SOUL COUNSELING PLLC
Entity type:Organization
Organization Name:DEL SOUL COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:KOWALKE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:623-261-8770
Mailing Address - Street 1:PO BOX 5231
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85385-5231
Mailing Address - Country:US
Mailing Address - Phone:602-785-2449
Mailing Address - Fax:
Practice Address - Street 1:15396 N 83RD AVE STE G103
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5629
Practice Address - Country:US
Practice Address - Phone:602-785-2449
Practice Address - Fax:602-785-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4545103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty