Provider Demographics
NPI:1568281277
Name:WILD AWAKENING COUNSELING AND HEALING LLC
Entity type:Organization
Organization Name:WILD AWAKENING COUNSELING AND HEALING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:970-430-6043
Mailing Address - Street 1:1800 WAZEE ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2526
Mailing Address - Country:US
Mailing Address - Phone:970-430-6043
Mailing Address - Fax:
Practice Address - Street 1:1800 WAZEE ST STE 300
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-2526
Practice Address - Country:US
Practice Address - Phone:970-430-6043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty