Healthcare Provider Details

I. General information

NPI: 1407248289
Provider Name (Legal Business Name): SIMPLY AWAKE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 SAWMILL RD STE C2 THE UNITY BARN
DOYLESTOWN PA
18902-9645
US

IV. Provider business mailing address

6597 GREENHILL RD
LUMBERVILLE PA
18933-9703
US

V. Phone/Fax

Practice location:
  • Phone: 267-454-8034
  • Fax:
Mailing address:
  • Phone: 267-454-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC005696
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPC005696
License Number StatePA

VIII. Authorized Official

Name: MR. JONATHAN ERIC LABMAN
Title or Position: PRESIDENT
Credential: M.A., LPC
Phone: 267-454-8034