Provider Demographics
NPI:1982413837
Name:SOUL FIRE WELLNESS LLC
Entity type:Organization
Organization Name:SOUL FIRE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:JANELLE
Authorized Official - Last Name:BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:412-212-3654
Mailing Address - Street 1:2555 WASHINGTON RD STE 610A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2574
Mailing Address - Country:US
Mailing Address - Phone:412-212-3654
Mailing Address - Fax:
Practice Address - Street 1:2555 WASHINGTON RD STE 610A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15241-2574
Practice Address - Country:US
Practice Address - Phone:412-212-3654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty