Provider Demographics
NPI:1720434350
Name:NUTURING THE SOUL LLC
Entity Type:Organization
Organization Name:NUTURING THE SOUL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTNACK
Authorized Official - Suffix:
Authorized Official - Credentials:MS LAC
Authorized Official - Phone:732-770-6029
Mailing Address - Street 1:39 WICK DR
Mailing Address - Street 2:
Mailing Address - City:FORDS
Mailing Address - State:NJ
Mailing Address - Zip Code:08863-1406
Mailing Address - Country:US
Mailing Address - Phone:732-770-6029
Mailing Address - Fax:
Practice Address - Street 1:39 WICK DR
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-1406
Practice Address - Country:US
Practice Address - Phone:732-770-6029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00195200251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health