Soul Growth LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

10492016-3501 Issued in UT

Legal business name

SOUL GROWTH LLC

Practice address

1719 S Main St
Salt Lake City, UT 84115-1911

Phone

(307) 389-8044

NPI assigned

Nov 2, 2017

Organization subpart

No

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

Authorized official

Name

Mrs. Jessica L Vasa, LCSW

Title

Mental Health Clinician

Phone

(307) 389-8044

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510617600000",
    "number": "1417469115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2011 S 2100 E APT 306",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841083176",
            "telephone_number": "307-389-8044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 S MAIN ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841151911",
            "telephone_number": "307-389-8044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL GROWTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2017-11-14",
        "status": "A",
        "authorized_official_last_name": "VASA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MENTAL HEALTH CLINICIAN",
        "authorized_official_telephone_number": "307-389-8044",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "UT",
            "license": "10492016-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valencia Soto
• Bahman Sotoodian, MD, FRCP(C), FAAD
• Marissa Souder
• Sami Soufi
• Cora Souimanyphanh
• Soul Perch Counseling, PLLC
• Silvia M Soule
• Scott Martin Soulier, DPM, MSPH
• Sound Minds LLC
• Sound Sleep Medical

• All providers in Salt Lake City, UT
• Mental Health Clinic/Center (Including Community Mental Health Center) in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2017; 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.