| Awaken Freedom, Llc | |
|
581 W 17th Ave Eugene OR 97401-3816 | |
| (541) 204-2462 | |
| Not Available |
| Full Name | Awaken Freedom, Llc |
|---|---|
| Speciality | Counselor |
| Location | 581 W 17th Ave, Eugene, Oregon |
| Authorized Official Name and Position | Rebecca Suzanne Perdew (OWNER) |
| Authorized Official Contact | 5412042462 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Awaken Freedom, Llc 581 W 17th Ave Eugene OR 97401-3816 Ph: (541) 204-2462 | Awaken Freedom, Llc 581 W 17th Ave Eugene OR 97401-3816 Ph: (541) 204-2462 |
| NPI Number | 1669029708 |
|---|---|
| Provider Enumeration Date | 08/22/2019 |
| Last Update Date | 07/24/2020 |
| Certification Date | 07/24/2020 |
| Medicare PECOS PAC ID | 1355773060 |
|---|---|
| Medicare Enrollment ID | O20191119001655 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669029708 | NPI | - | NPPES |
| 500668772 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Rebecca S Perdew |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1023430774 PECOS PAC ID: 2264864974 Enrollment ID: I20191119001700 |
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