Provider Demographics
NPI:1497026371
Name:THERAPEUTIC AWAKENINGS, LLC
Entity Type:Organization
Organization Name:THERAPEUTIC AWAKENINGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:TRETTA
Authorized Official - Last Name:BRUGGER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:610-986-1160
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-0916
Mailing Address - Country:US
Mailing Address - Phone:610-986-1160
Mailing Address - Fax:
Practice Address - Street 1:223 BYERS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:CHESTER SPRINGS
Practice Address - State:PA
Practice Address - Zip Code:19425-9565
Practice Address - Country:US
Practice Address - Phone:610-986-1160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000523106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty