| Soul Growth Llc | |
|
1719 S Main St Salt Lake City UT 84115-1911 | |
| (307) 389-8044 | |
| Not Available |
| Full Name | Soul Growth Llc |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 1719 S Main St, Salt Lake City, Utah |
| Authorized Official Name and Position | Jessica L Vasa (MENTAL HEALTH CLINICIAN) |
| Authorized Official Contact | 3073898044 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Growth Llc 2011 S 2100 E Apt 306 Salt Lake City UT 84108-3176 Ph: (307) 389-8044 | Soul Growth Llc 1719 S Main St Salt Lake City UT 84115-1911 Ph: (307) 389-8044 |
| NPI Number | 1417469115 |
|---|---|
| Provider Enumeration Date | 11/02/2017 |
| Last Update Date | 11/14/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417469115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 10492016-3501 (Utah) | Primary |
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