Provider Demographics
NPI:1235977596
Name:SOUL SERENITY THERAPY, PLLC
Entity type:Organization
Organization Name:SOUL SERENITY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED INDEPENDENT SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELTNER
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:515-526-5870
Mailing Address - Street 1:809 WHEELER ST STE 110-342
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-4486
Mailing Address - Country:US
Mailing Address - Phone:515-526-5870
Mailing Address - Fax:
Practice Address - Street 1:809 WHEELER ST STE 110-342
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-4486
Practice Address - Country:US
Practice Address - Phone:515-231-6044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty