Provider Demographics
NPI:1245883362
Name:BEYOND AWARENESS, LLC
Entity type:Organization
Organization Name:BEYOND AWARENESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIDIK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-305-9384
Mailing Address - Street 1:3523 SOUTHPORT DR
Mailing Address - Street 2:
Mailing Address - City:ISLAND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60042-9143
Mailing Address - Country:US
Mailing Address - Phone:847-305-9384
Mailing Address - Fax:
Practice Address - Street 1:85 REVERE DR STE B
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-8001
Practice Address - Country:US
Practice Address - Phone:872-588-0687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty