Provider Demographics
NPI:1487539540
Name:SOUL ABA LLC
Entity type:Organization
Organization Name:SOUL ABA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/ MANAGER OF SOUL ABA LLC
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:HOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-520-8680
Mailing Address - Street 1:2356 HYACINTH LN
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1094
Mailing Address - Country:US
Mailing Address - Phone:870-520-8680
Mailing Address - Fax:870-520-8680
Practice Address - Street 1:2356 HYACINTH LN
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1094
Practice Address - Country:US
Practice Address - Phone:870-520-8680
Practice Address - Fax:870-520-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities