Provider Demographics
NPI:1285024463
Name:BALANCED AWAKENING, PC
Entity Type:Organization
Organization Name:BALANCED AWAKENING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:507-407-4363
Mailing Address - Street 1:4043 N RAVENSWOOD AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5683
Mailing Address - Country:US
Mailing Address - Phone:507-407-4363
Mailing Address - Fax:
Practice Address - Street 1:4043 N RAVENSWOOD AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-5683
Practice Address - Country:US
Practice Address - Phone:312-967-4669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty