NPIMap

Organization Active NPI

Soul Survivor Counseling Services PC

  • Mental Health Counselor
  • Bismarck, ND
National Provider Identifier
1831502152
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
260-1-1-93-5T Issued in ND
Legal business name
SOUL SURVIVOR COUNSELING SERVICES PC
Practice address
1110 College Dr Ste 206
Bismarck, ND 58501-1207
Phone
(701) 258-2008
Fax
(701) 223-9114
NPI assigned
Jun 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Ms. Andrea Martin, LPC, LPCCNPI 1447356506
Title
President
Phone
(701) 258-2008

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 260-1-1-93-5T ND Primary

Addresses

Primary practice location

1110 College Dr Ste 206
Bismarck, ND 58501-1207

Mailing address

1110 College Dr Ste 206
Bismarck, ND 58501-1207
Phone (701) 258-2008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250912002911 ND Part B Supplier - Clinic/Group Practice 3274036496 Receives reassigned benefits from 3 practitioners
Practice locations: Bismarck, ND

National Provider Directory

National Provider Directory

Locations

1120 College Dr
Ste 201
Bismarck, ND 58501

1110 College Dr
Ste 206
Bismarck, ND 58501
Phone (701) 258-2008

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1401840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1831502152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 COLLEGE DR STE 206",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585011207",
            "telephone_number": "701-258-2008",
            "fax_number": "701-223-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 COLLEGE DR STE 206",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585011207",
            "telephone_number": "701-258-2008",
            "fax_number": "701-223-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUL SURVIVOR COUNSELING SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-04",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-258-2008",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LPC, LPCC"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "ND",
            "license": "260-1-1-93-5T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.