Provider Demographics
NPI:1740064773
Name:RECOVERED SOUL
Entity type:Organization
Organization Name:RECOVERED SOUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAMILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:469-900-7964
Mailing Address - Street 1:5401 NAAMAN FOREST BLVD APT 426
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-5615
Mailing Address - Country:US
Mailing Address - Phone:469-900-7964
Mailing Address - Fax:
Practice Address - Street 1:5401 NAAMAN FOREST BLVD APT 426
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75044-5615
Practice Address - Country:US
Practice Address - Phone:469-900-7964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty