Provider Demographics
NPI:1356029045
Name:THE INTEGRATED SOUL, LLC
Entity type:Organization
Organization Name:THE INTEGRATED SOUL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:RUCCI
Authorized Official - Last Name:VOIGT
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-743-1983
Mailing Address - Street 1:2501 CHATHAM RD STE 4520
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-4188
Mailing Address - Country:US
Mailing Address - Phone:773-808-6033
Mailing Address - Fax:
Practice Address - Street 1:2501 CHATHAM RD STE 4520
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-4188
Practice Address - Country:US
Practice Address - Phone:773-808-6033
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health