Provider Demographics
NPI:1043016421
Name:SOULCARE INTEGRATIVE PSYCHIATRY LLC
Entity type:Organization
Organization Name:SOULCARE INTEGRATIVE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DINENNO
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:505-918-2501
Mailing Address - Street 1:12 MAIN ST UNIT 1239
Mailing Address - Street 2:
Mailing Address - City:LA LUZ
Mailing Address - State:NM
Mailing Address - Zip Code:88337-1651
Mailing Address - Country:US
Mailing Address - Phone:575-201-9860
Mailing Address - Fax:
Practice Address - Street 1:12 MAIN ST UNIT 1239
Practice Address - Street 2:
Practice Address - City:LA LUZ
Practice Address - State:NM
Practice Address - Zip Code:88337-1651
Practice Address - Country:US
Practice Address - Phone:505-918-2501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty