SOUL GROWTH LLC NPI 1417469115

NPI Information

  • NPI: 1417469115
  • Provider Name: SOUL GROWTH LLC
  • Classification: Clinic/Center - 261QM0801X
  • Specialization: Mental Health (Including Community Mental Health Center)
  • Entity Type: Organization
  • Address: 1719 S MAIN ST
    SALT LAKE CITY, UT
    ZIP 84115
  • Phone: (307) 389-8044

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NPI Details

SOUL GROWTH LLC is a mental health (including community mental health center) clinic center in Salt Lake City, UT. SOUL GROWTH LLC NPI is 1417469115. The provider is registered as an organization entity type.

The provider's business location address is:

1719 S MAIN ST
SALT LAKE CITY, UT
ZIP 84115-911
Phone: (307) 389-8044

The provider's authorized official is Jessica L Vasa .
The authorized official title is Mental Health Clinician and has the following contact phone number (307) 389-8044.

The enumeration date for this NPI number is 11/2/2017 and was last updated on 11/14/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0801XClinic/CenterMental Health (Including Community Mental Health Center)10492016-3501UTAHYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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