Provider Demographics
NPI:1750450755
Name:AWAKEN TO CHANGE, P.C.
Entity Type:Organization
Organization Name:AWAKEN TO CHANGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:515-244-7007
Mailing Address - Street 1:950 OFFICE PARK RD
Mailing Address - Street 2:STE 200B
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-2549
Mailing Address - Country:US
Mailing Address - Phone:515-244-7007
Mailing Address - Fax:515-244-3238
Practice Address - Street 1:950 OFFICE PARK RD
Practice Address - Street 2:STE 200B
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2549
Practice Address - Country:US
Practice Address - Phone:515-244-7007
Practice Address - Fax:515-244-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2009-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00263103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty