Provider Demographics
NPI:1174976435
Name:AWAKENED MIND, LLC
Entity type:Organization
Organization Name:AWAKENED MIND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:GLANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, CCMHC
Authorized Official - Phone:561-420-4031
Mailing Address - Street 1:7401 WILES ROAD
Mailing Address - Street 2:SUITE 253
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067
Mailing Address - Country:US
Mailing Address - Phone:561-420-4031
Mailing Address - Fax:954-827-0297
Practice Address - Street 1:7401 WILES ROAD
Practice Address - Street 2:SUITE 253
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067
Practice Address - Country:US
Practice Address - Phone:561-420-4031
Practice Address - Fax:954-827-0297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH11538251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health