Provider Demographics
NPI:1922836980
Name:AWE THERAPY
Entity type:Organization
Organization Name:AWE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-361-6504
Mailing Address - Street 1:5844 OAKLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1918
Mailing Address - Country:US
Mailing Address - Phone:319-360-5768
Mailing Address - Fax:
Practice Address - Street 1:4470 W 78TH STREET CIR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55435-5408
Practice Address - Country:US
Practice Address - Phone:612-208-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty