Provider Demographics
NPI:1922588102
Name:AWAKE IN WELLNESS, LLC
Entity Type:Organization
Organization Name:AWAKE IN WELLNESS, LLC
Other - Org Name:AWAKE IN WELLNESS MUSIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DITTY
Authorized Official - Suffix:
Authorized Official - Credentials:MM, MT-BC
Authorized Official - Phone:303-349-8918
Mailing Address - Street 1:1430 NELSON RD STE 221
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6399
Mailing Address - Country:US
Mailing Address - Phone:203-403-8697
Mailing Address - Fax:
Practice Address - Street 1:1430 NELSON RD STE 221
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6399
Practice Address - Country:US
Practice Address - Phone:720-340-3869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-17
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11114225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid