MEDICARE: COSMIC AWAKENING FAMILY THERAPY & COUNSELING PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	106H00000X	Marriage & Family Therapist
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1467383497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COSMIC AWAKENING FAMILY THERAPY & COUNSELING PC

Provider Business Mailing Address
First Line	:	1014 S WESTLAKE BLVD # 14-341
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	28310 ROADSIDE DR STE 111
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-4947
Country	:	US
Telephone Number	:	714-576-6307
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VALERIYA BAUER
Credential	:	MA, LMFT, LPCC
Telephone Number	:	818-939-2795

Provider Enumeration Date	:	05/27/2026
Last Update Date	:	05/27/2026

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