| Soul Apothecary, Llc | |
|
787 Sunset Blvd O Fallon IL 62269-1960 | |
| (618) 292-8964 | |
| Not Available |
| Full Name | Soul Apothecary, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 787 Sunset Blvd, O Fallon, Illinois |
| Authorized Official Name and Position | Mallory Prindable (MENTAL HEALTH THERAPIST/OWNER) |
| Authorized Official Contact | 6182928964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Apothecary, Llc 306 Emily Cir O Fallon IL 62269-1301 Ph: (618) 292-8964 | Soul Apothecary, Llc 787 Sunset Blvd O Fallon IL 62269-1960 Ph: (618) 292-8964 |
| NPI Number | 1417699471 |
|---|---|
| Provider Enumeration Date | 04/11/2022 |
| Last Update Date | 01/09/2023 |
| Certification Date | 01/09/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417699471 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
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