Provider Demographics
NPI:1780265983
Name:SACRED SOL COUNSELING LLC
Entity type:Organization
Organization Name:SACRED SOL COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS MATHESON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:435-229-7178
Mailing Address - Street 1:165 N 100 E STE 3
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2505
Mailing Address - Country:US
Mailing Address - Phone:435-229-7178
Mailing Address - Fax:435-215-2797
Practice Address - Street 1:165 N 100 E STE 3
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2505
Practice Address - Country:US
Practice Address - Phone:435-229-7178
Practice Address - Fax:435-215-2797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty