Provider Demographics
NPI:1184009508
Name:ADVANCED AWARENESS COUNSELING, LLC.
Entity Type:Organization
Organization Name:ADVANCED AWARENESS COUNSELING, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:V
Authorized Official - Last Name:MACIAS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:408-420-5730
Mailing Address - Street 1:4141 S HIGHLAND DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2642
Mailing Address - Country:US
Mailing Address - Phone:408-420-5730
Mailing Address - Fax:
Practice Address - Street 1:4125 N CANYON RD
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-5015
Practice Address - Country:US
Practice Address - Phone:408-420-5730
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8173984-6009101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1568720472Medicaid