Provider Demographics
NPI:1114754256
Name:AWAKENING YOUR AUTHENTICITY LLC
Entity type:Organization
Organization Name:AWAKENING YOUR AUTHENTICITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAYBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:602-561-7078
Mailing Address - Street 1:4714 NW 135TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-1566
Mailing Address - Country:US
Mailing Address - Phone:602-561-7078
Mailing Address - Fax:
Practice Address - Street 1:722 N SUMNER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2641
Practice Address - Country:US
Practice Address - Phone:737-999-0744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health