| Soulegria Llc | |
|
11 S Main St Hurricane UT 84737-1949 | |
| (800) 792-0435 | |
| (877) 698-4968 |
| Full Name | Soulegria Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 11 S Main St, Hurricane, Utah |
| Authorized Official Name and Position | Tyler Olsen (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 8012856100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Soulegria Llc 11 S Main St Hurricane UT 84737-1949 Ph: (800) 792-0435 | Soulegria Llc 11 S Main St Hurricane UT 84737-1949 Ph: (800) 792-0435 |
| NPI Number | 1225648199 |
|---|---|
| Provider Enumeration Date | 08/05/2020 |
| Last Update Date | 11/12/2021 |
| Certification Date | 11/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225648199 | 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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