Soulful Spaces Therapy PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SOULFUL SPACES THERAPY PLLC

Practice address

1400 Eberhart Ave
Edwardsville, IL 62025-1013

Phone

(217) 871-1089

NPI assigned

Jun 14, 2024

Organization subpart

No

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

Authorized official

Name

Shyanna Kirby, LCSWNPI 1477126340

Title

Owner

Phone

(217) 871-1089

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shyanna Kirby, LCSW

  • Clinical Social Worker
  • Edwardsville, IL
  • NPI 1477126340
  NPD Authorized official

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

{
    "created_epoch": "1718323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720742400000",
    "number": "1255174447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 EBERHART AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251013",
            "telephone_number": "217-871-1089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 EBERHART AVE",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620251013",
            "telephone_number": "217-871-1089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULFUL SPACES THERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-14",
        "last_updated": "2024-07-12",
        "certification_date": "2024-07-12",
        "status": "A",
        "authorized_official_last_name": "KIRBY",
        "authorized_official_first_name": "SHYANNA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "217-871-1089",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brandy Lynn Smith, LCPC
• Jason Smith, NP
• Vanessa Smith
• Clayton Allen Snyders, RN
• Ellen Snyders
• Southern Illinois Neuropsychology LLC
• Southern Illinois Pediatric Dentistry of Edwardsville
• Nancy C Spina
• Sportchiro, LLC
• Lynette Kathleen Sproull, CCC-SLP

• Clinical Social Worker in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; 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.