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General NPI Number Information
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NPI Number | 1619572336
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Entity Type | Organization
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Legal Business Name | AWAKEN THERAPY
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/16/2020
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Provider Practice Location Address
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Address Line | 6010 W SPRING CREEK PKWY # 246
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City | PLANO
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State | TX
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Zip | 75024-3569
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Country | US
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Telephone | 972-643-8243
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Fax |
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Provider Business Mailing Address
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Address Line | 6010 W SPRING CREEK PKWY # 246
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City | PLANO
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State | TX
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Zip | 75024-3569
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Country | US
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Telephone | 972-643-8243
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Fax |
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Authorized Official
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Title or Position | OWNER/ THERAPIST
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Name | RACHEL E NANNEY
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Credential | LPC-S
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Telephone | 972-979-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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