Soulmosaic, PLLC

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

SOULMOSAIC, PLLC

Practice address

240 Scott Ave Ste 4
Morgantown, WV 26508-8805

Phone

(304) 685-8967

NPI assigned

May 19, 2021

Last updated

May 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Nicole Matala, LICSWNPI 1548519762

Title

Owner

Phone

(304) 685-8967

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jessica Nicole Matala, LGSW

  • Social Worker
  • Morgantown, WV
  • NPI 1548519762
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1013581404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 LAKE ST",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265053312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 SCOTT AVE STE 4",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265088805",
            "telephone_number": "304-685-8967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULMOSAIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "MATALA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-685-8967",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LISCW",
            "identifier": "DP00944408",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cirsten Sonntag
• Regan Brooke Sorrell
• Talia B Sotomayor, M.D.
• Claire Soucier
• Lynsey Soule, MD
• Timothy South, PHARMD
• Holly Paige Southers, PA
• Briana Sowers, DO
• Natalie Sowko, RN, BSN, DNAP
• Sandra Spadafore

• Counselor in Morgantown, WV
• Providers in Morgantown, WV by specialty
• Counselor in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.