MEDICARE: AWAKE THERAPY MANAGEMENT PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	183500000X	Pharmacist
3	1835P1200X	Pharmacotherapy Pharmacist
4	1835P1300X	Psychiatric Pharmacist
5	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1528850971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWAKE THERAPY MANAGEMENT PLLC

Provider Business Mailing Address
First Line	:	9310 SAN MARCO DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-7376
Country	:	US
Telephone Number	:	317-965-7887
Fax Number	:

Provider Business Practice Location Address
First Line	:	9310 SAN MARCO DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77459-7376
Country	:	US
Telephone Number	:	317-965-7887
Fax Number	:	866-844-9064

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. JULIAN HENDERSON
Credential	:
Telephone Number	:	317-965-7887

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	05/21/2025

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