Organization
SOUL SPARK THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA RUH LMHC, NCC (LICENSED MENTAL HEALTH COUNSELOR)
(407) 588-7244
Entity
Organization
Contact information
Practice address
140 SEPP RD, DEBARY, FL 32713-3914
(407) 588-7244
Mailing address
1317 EDGEWATER DR # 1732, ORLANDO, FL 32804-6350
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1669236212
NPI TYPE 1
FL
Enumeration date
07/09/2024
Last updated
07/09/2024
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