MEDICARE: AWAKEN YOUR SERENITY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1427879683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AWAKEN YOUR SERENITY, PLLC

Provider Business Mailing Address
First Line	:	8404 S COUNTRY CLUB DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-5814
Country	:	US
Telephone Number	:	405-323-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	8524 S WESTERN AVE STE 115
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73139-9248
Country	:	US
Telephone Number	:	405-323-2317
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MACKENZIE CAMPOS
Credential	:	LADC, LPC
Telephone Number	:	405-323-2317

Provider Enumeration Date	:	10/21/2024
Last Update Date	:	09/04/2025

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