Provider Demographics
NPI:1982234662
Name:SOULFUEL THERAPY LLC
Entity Type:Organization
Organization Name:SOULFUEL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:832-549-1356
Mailing Address - Street 1:21801 NORTHCREST DR APT 833
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-4065
Mailing Address - Country:US
Mailing Address - Phone:832-549-1356
Mailing Address - Fax:
Practice Address - Street 1:17302 HOUSE HAHL RD STE 302
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8211
Practice Address - Country:US
Practice Address - Phone:832-549-1356
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty