Soul Survivors LLC

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

SOUL SURVIVORS LLC

Practice address

109 Mount Carmel Dr
Natchez, MS 39120-2237

Phone

(601) 807-4715

NPI assigned

Nov 14, 2023

Last updated

Nov 14, 2023By 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

Lyvetta Renee Mickell

Title

Ceo/Owner

Phone

(601) 807-4715

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1699920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699920000000",
    "number": "1013781509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 MOUNT CARMEL DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391202237",
            "telephone_number": "601-807-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 MOUNT CARMEL DR",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391202237",
            "telephone_number": "601-807-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SURVIVORS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-14",
        "last_updated": "2023-11-14",
        "certification_date": "2023-11-14",
        "status": "A",
        "authorized_official_last_name": "MICKELL",
        "authorized_official_first_name": "LYVETTA",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "601-807-4715"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica A Smith
• Paul Eugene Smith, CRNA
• Tracy Lynette Smith
• Valenthia Smith
• Mary Katherine Soderstrom, MS CCC-SLP
• Southwest Mississippi Planning and Development District
• Southwest Mississippi Planning and Development District
• Southwest Mississippi Planning and Development District
• Delores Lanehart Spinks, FNPC
• Billy Starr, CRNA

• Emotionally Disturbed Childrens' Residential Treatment Facility in Natchez, MS
• Providers in Natchez, MS by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2023; 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.