Provider Demographics
NPI:1164145470
Name:AWAKENING WHOLENESS LLC
Entity Type:Organization
Organization Name:AWAKENING WHOLENESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:303-521-6463
Mailing Address - Street 1:5123 W 98TH ST # 2055
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55437-2040
Mailing Address - Country:US
Mailing Address - Phone:612-239-1464
Mailing Address - Fax:
Practice Address - Street 1:9300 HENNEPIN TOWN RD STE B
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55347-3072
Practice Address - Country:US
Practice Address - Phone:303-521-6463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty