| Feed Your Soul LLC | |
|
2917 N Highland Ave Jackson TN 38305-3407 | |
| (731) 300-1010 | |
| (731) 214-1816 |
| Full Name | Feed Your Soul LLC |
|---|---|
| Speciality | Social Worker |
| Location | 2917 N Highland Ave, Jackson, Tennessee |
| Authorized Official Name and Position | Traci Schott (LCSW/OWNER) |
| Authorized Official Contact | 7314008022 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Feed Your Soul LLC Po Box 10233 Jackson TN 38308-0103 Ph: (731) 400-8022 | Feed Your Soul LLC 2917 N Highland Ave Jackson TN 38305-3407 Ph: (731) 300-1010 |
| NPI Number | 1215410816 |
|---|---|
| Provider Enumeration Date | 09/10/2018 |
| Last Update Date | 11/17/2024 |
| Certification Date | 11/17/2024 |
| Medicare PECOS PAC ID | 7214288018 |
|---|---|
| Medicare Enrollment ID | O20180918001683 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215410816 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (NU) | Primary |
| Provider Name | Traci Schott |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932217783 PECOS PAC ID: 6507963246 Enrollment ID: I20070908000002 |
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