| Soma Recovery Llc | |
|
825 N Waco Ave Wichita KS 67203-3939 | |
| (316) 201-6047 | |
| (316) 221-7157 |
| Full Name | Soma Recovery Llc |
|---|---|
| Speciality | Counselor |
| Location | 825 N Waco Ave, Wichita, Kansas |
| Authorized Official Name and Position | Jenny Helms (OWNER, THERAPIST) |
| Authorized Official Contact | 7707154772 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soma Recovery Llc 825 N Waco Ave Wichita KS 67203-3939 Ph: (316) 201-6047 | Soma Recovery Llc 825 N Waco Ave Wichita KS 67203-3939 Ph: (316) 201-6047 |
| NPI Number | 1750850723 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 11/09/2021 |
| Certification Date | 11/09/2021 |
| Medicare PECOS PAC ID | 7810387339 |
|---|---|
| Medicare Enrollment ID | O20211123003204 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750850723 | NPI | - | NPPES |
| Provider Name | Michael L Nichols |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437180130 PECOS PAC ID: 6608831581 Enrollment ID: I20041120000127 |
| Provider Name | Laveta M Jarrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1588890404 PECOS PAC ID: 8628124229 Enrollment ID: I20090923000641 |
| Provider Name | Elesa Lynee Ignowski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942685151 PECOS PAC ID: 3971813650 Enrollment ID: I20151109002005 |
| Provider Name | Angela M Theobald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427570373 PECOS PAC ID: 6103196977 Enrollment ID: I20170727000415 |
| Provider Name | Natasha B O'donnell |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1114208576 PECOS PAC ID: 3870927312 Enrollment ID: I20191217000302 |
| Provider Name | Angela Armstrong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437891413 PECOS PAC ID: 4183005606 Enrollment ID: I20220714003717 |
| Provider Name | Samantha Rae Applebaum |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417448051 PECOS PAC ID: 1052793908 Enrollment ID: I20220809002234 |
| Provider Name | Samantha Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1013326719 PECOS PAC ID: 2769865005 Enrollment ID: I20220818001739 |
| Provider Name | Cissy Jo Stiles |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861025165 PECOS PAC ID: 9234588765 Enrollment ID: I20231209000458 |
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