Provider Demographics
NPI:1275178451
Name:AWAKEN360, INC.
Entity Type:Organization
Organization Name:AWAKEN360, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:417-251-1750
Mailing Address - Street 1:PO BOX 495
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-0495
Mailing Address - Country:US
Mailing Address - Phone:417-251-1750
Mailing Address - Fax:
Practice Address - Street 1:829 W ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-1517
Practice Address - Country:US
Practice Address - Phone:417-251-1750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251B00000XAgenciesCase Management
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty