NPIMap

Organization Active NPI

Awake Intumind, LLC

  • Mental Health Counselor
  • Brockton, MA
National Provider Identifier
1801270731
Registry record updated Feb 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
1032073 Issued in MA
Legal business name
AWAKE INTUMIND, LLC
Practice address
37 Belmont Street 3Rd Floor
Brockton, MA 02301
Phone
(617) 749-7484
Fax
(508) 510-3530
NPI assigned
Jul 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2016

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

Authorized official

Name
Mrs. Edna Laurent-Tellus, LICSWNPI 1891905311
Title
Ceo/Founder
Phone
(617) 947-1860

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 1032073 MA Primary

Addresses

Primary practice location

37 Belmont Street 3Rd Floor
Brockton, MA 02301

Mailing address

119 Christopher Road
Brockton, MA 02302
Phone (617) 749-7484

National Provider Directory

National Provider Directory

Locations

37 Belmont St
Fl 3
Brockton, MA 02301
Phone (617) 749-7484

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1436400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455235200000",
    "number": "1801270731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 CHRISTOPHER ROAD",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02302",
            "telephone_number": "617-749-7484",
            "fax_number": "508-510-3530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37 BELMONT STREET 3RD FLOOR",
            "city": "BROCKTON",
            "state": "MA",
            "postal_code": "02301",
            "telephone_number": "617-749-7484",
            "fax_number": "508-510-3530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKE INTUMIND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-09",
        "last_updated": "2016-02-12",
        "status": "A",
        "authorized_official_last_name": "LAURENT-TELLUS",
        "authorized_official_first_name": "EDNA",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "617-947-1860",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "1032073",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brockton, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; 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.