Provider Demographics
NPI:1215768635
Name:MYH LIBRARY / BEGIN TO WAKE THERAPY, LLC
Entity type:Organization
Organization Name:MYH LIBRARY / BEGIN TO WAKE THERAPY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:743-135-1374
Mailing Address - Street 1:733 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1246
Mailing Address - Country:US
Mailing Address - Phone:574-313-1374
Mailing Address - Fax:574-375-4165
Practice Address - Street 1:2314 MIAMI ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-1336
Practice Address - Country:US
Practice Address - Phone:574-533-1234
Practice Address - Fax:574-375-4165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty