| Ultimate Soul Psych Inc | |
|
2598 E Sunrise Blvd Ste 2104 Fort Lauderdale FL 33304-3230 | |
| (754) 300-7001 | |
| Not Available |
| Full Name | Ultimate Soul Psych Inc |
|---|---|
| Speciality | Counselor |
| Location | 2598 E Sunrise Blvd Ste 2104, Fort Lauderdale, Florida |
| Authorized Official Name and Position | Gabriela Alessandra Segnini (PRESIDENT) |
| Authorized Official Contact | 9546246929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ultimate Soul Psych Inc 2598 E Sunrise Blvd Ste 2104 Fort Lauderdale FL 33304-3230 Ph: (754) 300-7001 | Ultimate Soul Psych Inc 2598 E Sunrise Blvd Ste 2104 Fort Lauderdale FL 33304-3230 Ph: (754) 300-7001 |
| NPI Number | 1124635669 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 05/25/2021 |
| Certification Date | 05/25/2021 |
| Medicare PECOS PAC ID | 4385093632 |
|---|---|
| Medicare Enrollment ID | O20231212001192 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124635669 | NPI | - | NPPES |
| LMHC18408 | Other | FL | FLORIDA LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Gabriela Alessandra Segnini |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043718844 PECOS PAC ID: 5294184545 Enrollment ID: I20231222000637 |
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