Healthcare Provider Details

I. General information

NPI: 1932866225
Provider Name (Legal Business Name): AWESOME BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2021
Last Update Date: 11/21/2021
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3346 W SAINT GERMAIN ST APT 206
SAINT CLOUD MN
56301-3797
US

IV. Provider business mailing address

3346 W SAINT GERMAIN ST APT 206
SAINT CLOUD MN
56301-3797
US

V. Phone/Fax

Practice location:
  • Phone: 404-207-4246
  • Fax:
Mailing address:
  • Phone: 404-207-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HIRAT A MUSE
Title or Position: PROGRAM MANAGER
Credential:
Phone: 404-207-4246