NPIMap

Organization Active NPI

Soulegria LLC

  • Adult Mental Health Clinic/Center
  • Hurricane, UT
National Provider Identifier
1225648199
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
SOULEGRIA LLC
Practice address
11 S Main St
Hurricane, UT 84737-1949
Phone
(800) 792-0435
Fax
(877) 698-4968
NPI assigned
Aug 5, 2020
Last updated
Nov 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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

Authorized official

Name
Tyler Olsen
Title
Executive Director
Phone
(801) 285-6100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

11 S Main St
Hurricane, UT 84737-1949

Mailing address

11 S Main St
Hurricane, UT 84737-1949
Phone (800) 792-0435

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1596585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636675200000",
    "number": "1225648199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "HURRICANE",
            "state": "UT",
            "postal_code": "847371949",
            "telephone_number": "800-792-0435",
            "fax_number": "877-698-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 S MAIN ST",
            "city": "HURRICANE",
            "state": "UT",
            "postal_code": "847371949",
            "telephone_number": "800-792-0435",
            "fax_number": "877-698-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULEGRIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-05",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-285-6100"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hurricane, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 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.