1841639929 NPI number — AN AWAKENED HEART PSYCHOLOGICAL APPROACHES TOMENTALHEALTH WELLNESS LLC

Table of content: (NPI 1841639929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841639929 NPI number — AN AWAKENED HEART PSYCHOLOGICAL APPROACHES TOMENTALHEALTH WELLNESS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AN AWAKENED HEART PSYCHOLOGICAL APPROACHES TOMENTALHEALTH WELLNESS LLC
Provider Last Name:
Provider First Name:
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Provider's Other Name Information

Provider Other Organization Name:
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NPI Number Information

NPI Number:
1841639929
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8450 112TH ST APT 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33772-4221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 W KENNEDY BLVD
Provider Second Line Business Practice Location Address:
327
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-2288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-692-7364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SULLIVAN
Authorized Official First Name:
KEESHA
Authorized Official Middle Name:
MONAIE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-692-7364

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  SW 11227 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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