Healthcare Provider Details

I. General information

NPI: 1427879683
Provider Name (Legal Business Name): AWAKEN YOUR SERENITY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8524 S WESTERN AVE STE 115
OKLAHOMA CITY OK
73139-9248
US

IV. Provider business mailing address

8404 S COUNTRY CLUB DR
OKLAHOMA CITY OK
73159-5814
US

V. Phone/Fax

Practice location:
  • Phone: 405-323-2317
  • Fax:
Mailing address:
  • Phone: 405-323-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MACKENZIE CAMPOS
Title or Position: OWNER
Credential: LADC, LPC
Phone: 405-323-2317