Provider Demographics
NPI:1134338791
Name:AWARENESS LLC
Entity type:Organization
Organization Name:AWARENESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASTER SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHARTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMS
Authorized Official - Phone:208-353-2496
Mailing Address - Street 1:9533 BIRMINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-2202
Mailing Address - Country:US
Mailing Address - Phone:208-353-2496
Mailing Address - Fax:208-658-8433
Practice Address - Street 1:9533 BIRMINGHAM DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-2202
Practice Address - Country:US
Practice Address - Phone:208-353-2496
Practice Address - Fax:208-658-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-25856251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health