Soulreconstruct Psychotherapy

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

SOULRECONSTRUCT PSYCHOTHERAPY

Practice address

1136 S Delano CT W Ste B201
Chicago, IL 60605-3734

Phone

(312) 476-9682

NPI assigned

Jul 19, 2021

Last updated

Jul 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

Sierria Channing Coleman, LCPCNPI 1639528219

Title

Owner/Lic Clini Coun

Phone

(615) 424-2761

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 2

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.

• Sierria Channing Coleman, LCPC

  • Professional Counselor
  • Chicago, IL
  • NPI 1639528219
  NPD Authorized official
• Camarie Steward

  • Social Worker
  • Riverside, IL
  • NPI 1649922352
  NPD (past)

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

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626652800000",
    "number": "1083287924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 S DELANO CT W STE B201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053734",
            "telephone_number": "312-476-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 S DELANO CT W STE B201",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053734",
            "telephone_number": "312-476-9682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULRECONSTRUCT PSYCHOTHERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-19",
        "last_updated": "2021-07-19",
        "certification_date": "2021-07-19",
        "status": "A",
        "authorized_official_last_name": "COLEMAN",
        "authorized_official_first_name": "SIERRIA",
        "authorized_official_middle_name": "CHANNING",
        "authorized_official_title_or_position": "OWNER/LIC CLINI COUN",
        "authorized_official_telephone_number": "615-424-2761",
        "authorized_official_credential": "LCPC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "AVaility",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1136 S Delano Ct W Ste B201",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606053734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Soulective Pelvic Health and Wellness PLLC
• Cia Souleles
• Soulful Nutrition Consulting Inc
• Soulful RT
• Lioubov Soulii, M.D.,
• Soulstice Therapy PLLC
• Soulu (Madraigos Midwest)
• Soulwork, PLLC
• Souma Diagnostics, LTD
• Omar Souman, DMD, MS

• Mental Health Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Mental Health Counselor in Illinois

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