Healthcare Provider Details

I. General information

NPI: 1417646266
Provider Name (Legal Business Name): HEALTH-AWARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 E HIGHWAY 193 STE 102
LAYTON UT
84040-8573
US

IV. Provider business mailing address

1086 E HIGHWAY 193 STE 102
LAYTON UT
84040-8573
US

V. Phone/Fax

Practice location:
  • Phone: 208-970-9087
  • Fax:
Mailing address:
  • Phone: 208-970-9087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BEZZANT
Title or Position: OWNER
Credential: CMHC
Phone: 208-970-9087