Self-Awareness, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

1377 Issued in IA

Legal business name

SELF-AWARENESS, LLC

Practice address

2301 Forest Ave
Des Moines, IA 50311-3113

Phone

(515) 277-0320

Fax

(515) 277-0358

NPI assigned

Aug 26, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerome Miller, CADCNPI 1396146163

Title

Ececutive Director/Counselor

Phone

(515) 277-0320

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Self-Awareness LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Self-Awareness, LLC

  • Addiction (Substance Use Disorder) Counselor
  • Des Moines, IA
  • NPI 1336538180
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jerome Miller

  • Addiction (Substance Use Disorder) Counselor
  • Urbandale, IA
  • NPI 1396146163
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440547200000",
    "number": "1760859680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 FOREST AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503113113",
            "telephone_number": "515-277-0320",
            "fax_number": "515-277-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 FOREST AVE",
            "city": "DES MOINES",
            "state": "IA",
            "postal_code": "503113113",
            "telephone_number": "515-277-0320",
            "fax_number": "515-277-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF-AWARENESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-26",
        "last_updated": "2015-08-26",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "JEROME",
        "authorized_official_title_or_position": "ECECUTIVE DIRECTOR/COUNSELOR",
        "authorized_official_telephone_number": "515-277-0320",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CADC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "IA",
            "license": "1377",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "601004190",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kari Lynn Seivert, OTR/L, CLT-LANA
• Elaine Marie Harlan Selden, NP-C
• Select Specialty Hospital - Des Moines, Inc.
• Self-Alignment Evaluation and Outpatient Treatment Services, LLC
• Self-Awareness, LLC
• Myke Selha, L.I.S.W.
• Jennifer Ann Selix, RN
• Douglas E Selover, DO
• Sally Lynn Selover, IADC
• Ashlea Semmens, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Des Moines, IA
• Providers in Des Moines, IA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.