Provider Demographics
NPI:1124853239
Name:SOUL LOGIC COUNSELING
Entity type:Organization
Organization Name:SOUL LOGIC COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BOLLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:385-321-3109
Mailing Address - Street 1:4434 S HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MILLCREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84124-3533
Mailing Address - Country:US
Mailing Address - Phone:385-321-3109
Mailing Address - Fax:
Practice Address - Street 1:4434 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:MILLCREEK
Practice Address - State:UT
Practice Address - Zip Code:84124-3533
Practice Address - Country:US
Practice Address - Phone:385-321-3109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty