Provider Demographics
NPI:1902616907
Name:SOUL SPRING PSYCHIATRY
Entity type:Organization
Organization Name:SOUL SPRING PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:PRINCESS
Authorized Official - Middle Name:
Authorized Official - Last Name:AHEDOR
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:704-340-4431
Mailing Address - Street 1:2100 GEORGE DIETER DR # 960213
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3815
Mailing Address - Country:US
Mailing Address - Phone:704-340-4431
Mailing Address - Fax:
Practice Address - Street 1:2100 GEORGE DIETER DR # 960213
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3815
Practice Address - Country:US
Practice Address - Phone:704-340-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty