Provider Demographics
NPI:1427606136
Name:THE DAWN GODDESS LLC
Entity Type:Organization
Organization Name:THE DAWN GODDESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMIESSA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JUTTEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-465-2714
Mailing Address - Street 1:236 S 3RD ST # 308
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3618
Mailing Address - Country:US
Mailing Address - Phone:970-465-2714
Mailing Address - Fax:970-230-5913
Practice Address - Street 1:1010 S CASCADE AVE STE E
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4980
Practice Address - Country:US
Practice Address - Phone:970-465-2714
Practice Address - Fax:970-230-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty