Provider Demographics
NPI:1962262253
Name:DYNAMIC AWARENESS
Entity type:Organization
Organization Name:DYNAMIC AWARENESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-208-4022
Mailing Address - Street 1:2316 W MELROSE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6318
Mailing Address - Country:US
Mailing Address - Phone:312-208-4022
Mailing Address - Fax:
Practice Address - Street 1:2316 W MELROSE ST APT 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6318
Practice Address - Country:US
Practice Address - Phone:312-208-4022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty