Healthcare Provider Details

I. General information

NPI: 1235370495
Provider Name (Legal Business Name): AWAKENINGS COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E LOULA ST
OLATHE KS
66061-3437
US

IV. Provider business mailing address

200 E LOULA ST
OLATHE KS
66061-3437
US

V. Phone/Fax

Practice location:
  • Phone: 913-530-2577
  • Fax:
Mailing address:
  • Phone: 913-530-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC1970
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLSCSW1379
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC1970
License Number StateKS

VIII. Authorized Official

Name: MS. JACQUELINE D PATTISON
Title or Position: DIRECTOR
Credential: LPC
Phone: 913-530-2577