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General NPI Number Information
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NPI Number | 1285024463
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Entity Type | Organization
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Legal Business Name | BALANCED AWAKENING, PC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 02/05/2020
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Provider Practice Location Address
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Address Line | 4043 N RAVENSWOOD AVE STE 302
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City | CHICAGO
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State | IL
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Zip | 60613-5683
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Country | US
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Telephone | 312-967-4669
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Fax |
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Provider Business Mailing Address
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Address Line | 4043 N RAVENSWOOD AVE STE 302
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City | CHICAGO
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State | IL
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Zip | 60613-5683
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Country | US
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Telephone | 507-407-4363
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | HANNAH YANG
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Credential | PSY.D.
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Telephone | 507-407-4363
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008952
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License Number State | IL
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