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General NPI Number Information
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NPI Number | 1417521923
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Entity Type | Organization
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Legal Business Name | AWAKE WELLNESS CENTER LLC
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/19/2021
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Provider Practice Location Address
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Address Line | 8879 W FLAMINGO RD STE 101
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City | LAS VEGAS
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State | NV
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Zip | 89147-8732
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Country | US
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Telephone | 702-550-2491
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Fax |
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Provider Business Mailing Address
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Address Line | 4340 W ARBY AVE
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City | LAS VEGAS
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State | NV
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Zip | 89118-5108
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Country | US
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Telephone | 702-626-1072
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. KRISTINA A ANDAYA
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Credential | MFTI
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Telephone | 702-626-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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