Provider Demographics
NPI:1356056782
Name:SOUL SOIL HEALING LLC
Entity type:Organization
Organization Name:SOUL SOIL HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:T
Authorized Official - Last Name:GEBHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-280-2750
Mailing Address - Street 1:PO BOX 33458
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-0408
Mailing Address - Country:US
Mailing Address - Phone:218-280-2750
Mailing Address - Fax:
Practice Address - Street 1:3600 ROLAND AVE STE 4
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2437
Practice Address - Country:US
Practice Address - Phone:443-320-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-19
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty