| Soul Awakening LLC | |
|
4910 Normal Blvd Ste D Lincoln NE 68506-6300 | |
| (531) 500-4271 | |
| (531) 500-5447 |
| Full Name | Soul Awakening LLC |
|---|---|
| Speciality | Counselor |
| Location | 4910 Normal Blvd Ste D, Lincoln, Nebraska |
| Authorized Official Name and Position | Melissa Thorne (THERAPIST AND CEO) |
| Authorized Official Contact | 4028051099 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Soul Awakening LLC 2311 S 36th St Lincoln NE 68506-6626 Ph: (402) 805-1099 | Soul Awakening LLC 4910 Normal Blvd Ste D Lincoln NE 68506-6300 Ph: (531) 500-4271 |
| NPI Number | 1437932241 |
|---|---|
| Provider Enumeration Date | 08/15/2023 |
| Last Update Date | 04/25/2024 |
| Certification Date | 04/25/2024 |
| Medicare PECOS PAC ID | 5698217842 |
|---|---|
| Medicare Enrollment ID | O20240604001211 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437932241 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | () | Secondary |
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | () | Secondary |
| 101YM0800X | Counselor - Mental Health | () | Primary |
| Provider Name | Melissa Thorne |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1710429253 PECOS PAC ID: 8123560372 Enrollment ID: I20240604001323 |
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