Provider Demographics
NPI:1326545773
Name:HEALTHY SOUL TALK LLC
Entity type:Organization
Organization Name:HEALTHY SOUL TALK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-483-8455
Mailing Address - Street 1:1701 S 1ST AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-2419
Mailing Address - Country:US
Mailing Address - Phone:708-483-8455
Mailing Address - Fax:
Practice Address - Street 1:1701 S 1ST AVE STE 307
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-2419
Practice Address - Country:US
Practice Address - Phone:708-483-8455
Practice Address - Fax:708-776-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty