Provider Demographics
NPI:1669251195
Name:AWAKEN TELEPSYCHIATRY, LLC
Entity type:Organization
Organization Name:AWAKEN TELEPSYCHIATRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-877-1251
Mailing Address - Street 1:1313 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3533
Mailing Address - Country:US
Mailing Address - Phone:833-552-7149
Mailing Address - Fax:979-230-1029
Practice Address - Street 1:1313 HALL AVE
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3533
Practice Address - Country:US
Practice Address - Phone:833-552-7149
Practice Address - Fax:979-230-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)