Soul Practice Licensed Clinical Social Worker PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

SOUL PRACTICE LICENSED CLINICAL SOCIAL WORKER PC

Doing business as

Soul Practice Group

Practice address

657 South McDonnell Ave
East Los Angeles, CA 90022

Phone

(800) 621-8119

Fax

(800) 621-8119

NPI assigned

Feb 26, 2025

Last updated

Feb 26, 2025By 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

Karla Gomez, LCSWNPI 1043561996

Title

Owner

Phone

(800) 621-8119

Specialties & licenses 1

Addresses

Other names 1

• Soul Practice Group Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Karla Gomez

  • Clinical Social Worker
  • Los Angeles, CA
  • NPI 1043561996
  NPD Authorized official

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

{
    "created_epoch": "1740528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1689471708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1968 S COAST HWY # 2987",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926513681",
            "telephone_number": "800-621-8119",
            "fax_number": "800-621-8119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "657 SOUTH MCDONNELL AVE",
            "city": "EAST LOS ANGELES",
            "state": "CA",
            "postal_code": "90022",
            "telephone_number": "800-621-8119",
            "fax_number": "800-621-8119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL PRACTICE LICENSED CLINICAL SOCIAL WORKER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-26",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-19",
        "status": "A",
        "authorized_official_last_name": "GOMEZ",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "800-621-8119",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Soul Practice Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Andrea Romero Roel
• Erick Rubio
• Jeanette Maria Ruiz, FNP-C
• Jacqueline Sandoval
• Estella Sneider, PH.D.
• Spectera
• Dabrina L Suttle
• Mintra Tan, D.D.S.
• Keilyn Tanimoto, DPT
• Cindy Joana Tapia-Mendoza

• Clinical Social Worker in East Los Angeles, CA
• Providers in East Los Angeles, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.