Provider Demographics
NPI:1699570713
Name:SOULFULLY REWRITTEN THERAPY
Entity type:Organization
Organization Name:SOULFULLY REWRITTEN THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRITTNI
Authorized Official - Middle Name:A
Authorized Official - Last Name:INGVALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC, LADC
Authorized Official - Phone:952-314-4449
Mailing Address - Street 1:6600 CITY WEST PKWY STE 125
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3261
Mailing Address - Country:US
Mailing Address - Phone:952-314-4449
Mailing Address - Fax:
Practice Address - Street 1:6600 CITY WEST PKWY STE 125
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3261
Practice Address - Country:US
Practice Address - Phone:952-314-4449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty