Provider Demographics
NPI:1366073546
Name:AWAKENED LIFE HEALING, LLC
Entity type:Organization
Organization Name:AWAKENED LIFE HEALING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BUEHNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:410-303-8946
Mailing Address - Street 1:597 SUMMIT VIEW DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-3847
Mailing Address - Country:US
Mailing Address - Phone:314-640-5846
Mailing Address - Fax:314-677-3512
Practice Address - Street 1:10801 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-6055
Practice Address - Country:US
Practice Address - Phone:314-467-0441
Practice Address - Fax:314-677-3512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)