Provider Demographics
NPI:1396421665
Name:SOUL JOURNEY MATTERS LLC
Entity type:Organization
Organization Name:SOUL JOURNEY MATTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-461-5245
Mailing Address - Street 1:7125 FRUITVILLE RD UNIT 1214
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-8957
Mailing Address - Country:US
Mailing Address - Phone:316-461-5245
Mailing Address - Fax:
Practice Address - Street 1:7125 FRUITVILLE RD UNIT 1214
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-8957
Practice Address - Country:US
Practice Address - Phone:316-461-5245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-22
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty