Epiphany Soul

Primary specialty

Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X

Legal business name

EPIPHANY SOUL

Practice address

5900 Clover LN
Waco, TX 76710-2809

Phone

(254) 412-9073

NPI assigned

Oct 20, 2025

Last updated

Jun 4, 2026By 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

Kim Tatum, LCCA

Title

Owner/Executive Director

Phone

(254) 412-9073

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1760918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780531200000",
    "number": "1669349148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24245",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767024245",
            "telephone_number": "254-870-4049",
            "fax_number": "254-232-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 CLOVER LN",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767102809",
            "telephone_number": "254-412-9073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EPIPHANY SOUL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-10-20",
        "last_updated": "2026-06-04",
        "certification_date": "2026-06-04",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OWNER/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "254-412-9073",
        "authorized_official_credential": "LCCA"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ennoble Hospice TX LLC (Ennoble Care)
• Enrichment Training and Counseling Solutions, Inc.
• Mark Anthony Anahaw Entrolezo, PT
• Ep Homecare LLC (Visiting Angels)
• Epiphany Dermatology PA
• Ann Elizabeth Erickstad, MD
• Hannah Kathryn Ermon
• Shelby Erwin
• Esc IV, LP (Brookdale Lake Brazos)
• David J Escajeda Jr., PA-C

• Emotionally Disturbed Childrens' Residential Treatment Facility in Waco, TX
• Providers in Waco, TX by specialty
• Emotionally Disturbed Childrens' Residential Treatment Facility in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2026; 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.