1346561578 NPI number — HEART AND SOUL PERSONAL SERVICES AGENCY LLC

Table of content: JANIE LYNN THOMPSON M.ED, LPC (NPI 1205243227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346561578 NPI number — HEART AND SOUL PERSONAL SERVICES AGENCY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART AND SOUL PERSONAL SERVICES AGENCY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346561578
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23737 US HIGHWAY 33
Provider Second Line Business Mailing Address:
SUITE C1
Provider Business Mailing Address City Name:
ELKHART
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46517-3564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-875-5099
Provider Business Mailing Address Fax Number:
574-875-5044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23737 US HIGHWAY 33
Provider Second Line Business Practice Location Address:
SUITE C1
Provider Business Practice Location Address City Name:
ELKHART
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46517-3564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-875-5099
Provider Business Practice Location Address Fax Number:
574-875-5044
Provider Enumeration Date:
06/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
ANGELIA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
574-575-0960

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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