Organization
SOUL APOTHECARY, LLC
Active
Organization
SOUL APOTHECARY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALLORY PRINDABLE MSW, LCSW (MENTAL HEALTH THERAPIST/OWNER)
(618) 292-8964
Entity
Organization
Contact information
Practice address
787 SUNSET BLVD, O FALLON, IL 62269-1960
(618) 292-8964
Mailing address
306 EMILY CIR, O FALLON, IL 62269-1301
(618) 292-8964
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/11/2022
Last updated
01/09/2023
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