Provider Demographics
NPI:1932866225
Name:AWESOME BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:AWESOME BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HIRAT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-207-4246
Mailing Address - Street 1:3346 W SAINT GERMAIN ST APT 206
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-3797
Mailing Address - Country:US
Mailing Address - Phone:404-207-4246
Mailing Address - Fax:
Practice Address - Street 1:3346 W SAINT GERMAIN ST APT 206
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3797
Practice Address - Country:US
Practice Address - Phone:404-207-4246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-21
Last Update Date:2021-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health