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General NPI Number Information
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NPI Number | 1871262022
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Entity Type | Organization
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Legal Business Name | VAKEN INTEGRATED CARE LLC
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 11816 INWOOD RD PMB 70454
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City | DALLAS
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State | TX
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Zip | 75244
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Country | US
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Telephone | 833-825-3694
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Fax |
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Provider Business Mailing Address
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Address Line | 11816 INWOOD RD STE 70454
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City | DALLAS
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State | TX
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Zip | 75244-8011
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Country | US
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Telephone | 833-825-3694
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Fax |
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Authorized Official
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Title or Position | CONTACT
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Name | DR. JAMIE SUNDVALL
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Credential | PHD
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Telephone | 833-825-3694
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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