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Organization
EPIPHANY SOUL
Active
Organization
EPIPHANY SOUL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM TATUM LCCA (OWNER/EXECUTIVE DIRECTOR)
(254) 412-9073
Entity
Organization
Contact information
Practice address
5900 CLOVER LN, WACO, TX 76710-2809
(254) 412-9073
Mailing address
PO BOX 24245, WACO, TX 76702-4245
(254) 870-4049
(254) 232-0219
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/20/2025
Last updated
06/04/2026
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