Provider Demographics
NPI:1114255817
Name:AWAKENING MINDFUL POSSIBILITIES
Entity Type:Organization
Organization Name:AWAKENING MINDFUL POSSIBILITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O./ PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, APN-BC
Authorized Official - Phone:931-380-0677
Mailing Address - Street 1:109 KENSINGTON PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-8885
Mailing Address - Country:US
Mailing Address - Phone:931-380-0677
Mailing Address - Fax:931-380-0677
Practice Address - Street 1:109 KENSINGTON PL
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-8885
Practice Address - Country:US
Practice Address - Phone:931-380-0677
Practice Address - Fax:931-380-0677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014483363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty