Soul Apothecary, LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

SOUL APOTHECARY, LLC

Practice address

787 Sunset Blvd
O Fallon, IL 62269-1960

Phone

(618) 292-8964

NPI assigned

Apr 11, 2022

Organization subpart

No

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

Authorized official

Name

Mallory Prindable, MSW, LCSW

Title

Mental Health Therapist/Owner

Phone

(618) 292-8964

Specialties & licenses 2

Addresses

Locations

Practitioners 1

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

• Mallory Ann Cook, MSW, LCSW

  • Clinical Social Worker
  • O Fallon, IL
  • NPI 1851635338
  NPD

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673222400000",
    "number": "1417699471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 EMILY CIR",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691301",
            "telephone_number": "618-292-8964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "787 SUNSET BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691960",
            "telephone_number": "618-292-8964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL APOTHECARY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-11",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A",
        "authorized_official_last_name": "PRINDABLE",
        "authorized_official_first_name": "MALLORY",
        "authorized_official_title_or_position": "MENTAL HEALTH THERAPIST/OWNER",
        "authorized_official_telephone_number": "618-292-8964",
        "authorized_official_credential": "MSW, LCSW"
    },
    "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": []
}

• Macee Noelle Smith, CNP
• Tayler Smith
• Brian Paul Sneath, DMD
• Solwis Health Centers LLC
• Sos Crisis Intervention, LLC
• Soulwell LLC
• Southern Illinois Chiropractic Kinesiologypc
• Southern Illinois Healthcare Foundation Inc
• Ralph Douglas Spafford, P.A.-C
• Jamie Sparks

• Adult Mental Health Clinic/Center in O Fallon, IL
• Providers in O Fallon, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.