Provider Demographics
NPI:1780468132
Name:NEW AWAKENINGS COUNSELING
Entity type:Organization
Organization Name:NEW AWAKENINGS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC/LADC
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TWEEDT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:507-407-2177
Mailing Address - Street 1:1119 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MN
Mailing Address - Zip Code:56143-1207
Mailing Address - Country:US
Mailing Address - Phone:507-407-2177
Mailing Address - Fax:
Practice Address - Street 1:1119 GRANT ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MN
Practice Address - Zip Code:56143-1207
Practice Address - Country:US
Practice Address - Phone:507-407-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty