Provider Demographics
NPI:1306642590
Name:SOULBIRD INTEGRATIVE
Entity type:Organization
Organization Name:SOULBIRD INTEGRATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUDY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:773-353-6259
Mailing Address - Street 1:1941 HEMLOCK DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-2652
Mailing Address - Country:US
Mailing Address - Phone:773-353-6259
Mailing Address - Fax:
Practice Address - Street 1:1941 HEMLOCK DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-2652
Practice Address - Country:US
Practice Address - Phone:773-353-6259
Practice Address - Fax:903-265-4867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty