# EPIPHANY SOUL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669349148
- **Authorized official:** KIM TATUM LCCA (OWNER/EXECUTIVE DIRECTOR)
- **Authorized official phone:** (254) 412-9073

## Contact information

- **Practice address:** 5900 CLOVER LN, WACO, TX 76710-2809
- **Practice address phone:** (254) 412-9073
- **Mailing address:** PO BOX 24245, WACO, TX 76702-4245
- **Mailing address phone:** (254) 870-4049
- **Mailing address fax:** (254) 232-0219

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | — | Yes |

## Other

- **Enumeration date:** 10/20/2025
- **Last updated:** 06/04/2026