Healthcare Provider Details

I. General information

NPI: 1962147561
Provider Name (Legal Business Name): AWAKE IN WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2022
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 BUENA VISTA CT
BRIGHTON CO
80601-3498
US

IV. Provider business mailing address

406 BUENA VISTA CT
BRIGHTON CO
80601-3498
US

V. Phone/Fax

Practice location:
  • Phone: 303-349-8918
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State

VIII. Authorized Official

Name: JESSICA M DITTY
Title or Position: OPERATING MANAGER
Credential: MT-BC
Phone: 303-349-8918