Provider Demographics
NPI:1457930950
Name:PRESENT AWAKENINGS THERAPY CENTER, PLLC
Entity type:Organization
Organization Name:PRESENT AWAKENINGS THERAPY CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:RHOADES
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-217-8851
Mailing Address - Street 1:3166 N LINCOLN AVE STE 214A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3119
Mailing Address - Country:US
Mailing Address - Phone:773-217-8851
Mailing Address - Fax:872-813-4218
Practice Address - Street 1:3166 N LINCOLN AVE STE 214A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3119
Practice Address - Country:US
Practice Address - Phone:773-217-8851
Practice Address - Fax:872-813-4218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2021-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health