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General NPI Number Information
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NPI Number | 1528850971
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Entity Type | Organization
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Legal Business Name | AWAKE THERAPY MANAGEMENT PLLC
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 9310 SAN MARCO DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-7376
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Country | US
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Telephone | 317-965-7887
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Fax | 866-844-9064
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Provider Business Mailing Address
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Address Line | 9310 SAN MARCO DR
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City | MISSOURI CITY
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State | TX
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Zip | 77459-7376
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Country | US
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Telephone | 317-965-7887
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JULIAN HENDERSON
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Credential |
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Telephone | 317-965-7887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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