MEDICARE: THE AWAKENING CENTER, PC

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	180000920	IL

General Provider Information

NPI Number	:	1013055961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE AWAKENING CENTER, PC

Provider Business Mailing Address
First Line	:	8700 MAJOR AVE
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3134
Country	:	US
Telephone Number	:	773-929-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2109
Country	:	US
Telephone Number	:	773-929-6262
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	AMY Y GRABOWSKI
Credential	:	MA, LCPC
Telephone Number	:	773-929-6262

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/03/2013

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