1457930950 NPI number — PRESENT AWAKENINGS THERAPY CENTER, PLLC

Table of content: WILLIAM DEAN EDWARDS M.D. (NPI 1689645731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457930950 NPI number — PRESENT AWAKENINGS THERAPY CENTER, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESENT AWAKENINGS THERAPY CENTER, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457930950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1332 N HALSTED ST STE 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60642-2637
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-217-8860
Provider Business Mailing Address Fax Number:
773-442-0350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1332 N HALSTED ST STE 403
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60642-2637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-217-8860
Provider Business Practice Location Address Fax Number:
773-442-0350
Provider Enumeration Date:
04/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
RHOADES
Authorized Official First Name:
STACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
773-217-8851

Provider Taxonomy Codes

  • Taxonomy code: 261QM0850X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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