Provider Demographics
NPI:1841983988
Name:SOUL THERAPY INC
Entity type:Organization
Organization Name:SOUL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:NISHAT
Authorized Official - Middle Name:SHAMS
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:773-232-1815
Mailing Address - Street 1:6510 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3919
Mailing Address - Country:US
Mailing Address - Phone:773-232-1815
Mailing Address - Fax:
Practice Address - Street 1:15 BEECHNUT DR
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9514
Practice Address - Country:US
Practice Address - Phone:773-232-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty