Provider Demographics
NPI:1538352828
Name:AWARENESS CENTER FOR COUNSELING
Entity type:Organization
Organization Name:AWARENESS CENTER FOR COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:TOMAZIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-782-2060
Mailing Address - Street 1:PO BOX 1294
Mailing Address - Street 2:167 W. BRIDGE ST.
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1294
Mailing Address - Country:US
Mailing Address - Phone:208-782-2060
Mailing Address - Fax:208-782-0209
Practice Address - Street 1:167 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2704
Practice Address - Country:US
Practice Address - Phone:208-782-2060
Practice Address - Fax:208-782-0209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806226200Medicaid
ID805932700Medicaid