Soulstice Therapeutic Solutions, LLC

Primary specialty

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

License

MH13683 Issued in FL

Legal business name

SOULSTICE THERAPEUTIC SOLUTIONS, LLC

Practice address

901 W Main St Ste 121
Wauchula, FL 33873-2532

Phone

(863) 773-6573

NPI assigned

Sep 7, 2016

Organization subpart

No

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

Authorized official

Name

Mr. Micah S. Hendrickson, LMHC

Title

Owner

Phone

(863) 773-6573

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473206400000",
    "number": "1821545815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 577",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338730577",
            "telephone_number": "863-773-6573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MAIN ST STE 121",
            "city": "WAUCHULA",
            "state": "FL",
            "postal_code": "338732532",
            "telephone_number": "863-773-6573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOULSTICE THERAPEUTIC SOLUTIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "MICAH",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-773-6573",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LMHC"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "FL",
            "license": "MH13683",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark D Sevigny, O.D.
• SF III TLF, LLC (Finr)
• Gloria Jean Shackelford
• Douglas Oliver Smith, MOT, OTRL, ABDA
• Sonni's Pediatrics, Inc.
• Southern Parks Inc (Southern Oaks Alf)
• Spark Your Heart, LLC
• Josie Spencer
• St Amaro Opco LLC (Vivo Healthcare Wauchula)
• Lorena Stoddard, LMT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Wauchula, FL
• Providers in Wauchula, FL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2016; 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.