Organization
SOUL GROWTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA L VASA LCSW (MENTAL HEALTH CLINICIAN)
(307) 389-8044
Entity
Organization
Contact information
Practice address
1719 S MAIN ST, SALT LAKE CITY, UT 84115-1911
(307) 389-8044
Mailing address
2011 S 2100 E APT 306, SALT LAKE CITY, UT 84108-3176
(307) 389-8044
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
10492016-3501
UT
Other
Enumeration date
11/02/2017
Last updated
11/14/2017
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