Provider Demographics
NPI:1316680259
Name:NOURISHING SOUL THERAPY, LLC
Entity type:Organization
Organization Name:NOURISHING SOUL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED CLINICAL SOCIAL WORK
Authorized Official - Prefix:
Authorized Official - First Name:MONIKA
Authorized Official - Middle Name:S
Authorized Official - Last Name:EICHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-844-7685
Mailing Address - Street 1:67 BEAVER WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04222-5491
Mailing Address - Country:US
Mailing Address - Phone:207-844-7685
Mailing Address - Fax:
Practice Address - Street 1:53 MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1234
Practice Address - Country:US
Practice Address - Phone:207-844-7685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1104340744OtherCOMMERCIAL INSURANCE USING TYPE 1 NPI