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General NPI Number Information
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NPI Number | 1023707544
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Entity Type | Organization
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Legal Business Name | AWAKENED VITALITY, LLC
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Dates
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Enumeration Date | 05/01/2023
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 7475 HUBBARD AVE STE 203
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City | MIDDLETON
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State | WI
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Zip | 53562-3146
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Country | US
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Telephone | 608-620-3062
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Fax |
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Provider Business Mailing Address
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Address Line | 7306 COMPANION LN
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City | MIDDLETON
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State | WI
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Zip | 53562-1033
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Country | US
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Telephone | 608-501-4488
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | CASEY-ANN R DOHSE
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Credential | LMFT
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Telephone | 608-501-4488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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