| Awakened Phoenix Llc | |
|
900 Wabash Ave Terre Haute IN 47807-3245 | |
| (812) 244-3919 | |
| (812) 286-9183 |
| Full Name | Awakened Phoenix Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 900 Wabash Ave, Terre Haute, Indiana |
| Authorized Official Name and Position | Peggy Escobedo (OWNER/CLINICIAN) |
| Authorized Official Contact | 8122443919 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Awakened Phoenix Llc 27 Allendale Terre Haute IN 47802-4751 Ph: (812) 244-3919 | Awakened Phoenix Llc 900 Wabash Ave Terre Haute IN 47807-3245 Ph: (812) 244-3919 |
| NPI Number | 1215742085 |
|---|---|
| Provider Enumeration Date | 02/10/2025 |
| Last Update Date | 02/10/2025 |
| Certification Date | 02/10/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215742085 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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