Provider Demographics
NPI:1982246286
Name:SOUL GROWTH PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:SOUL GROWTH PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:SOUL GROWTH PSYCHOLOGICAL SERVICES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:TUPLING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LLP
Authorized Official - Phone:248-840-5933
Mailing Address - Street 1:3760 SLEETH RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1670
Mailing Address - Country:US
Mailing Address - Phone:248-840-5933
Mailing Address - Fax:
Practice Address - Street 1:3760 SLEETH RD
Practice Address - Street 2:
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-1670
Practice Address - Country:US
Practice Address - Phone:248-840-5933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1639592785OtherBLUE CROSS BLUE SHIELD