Awake for Life, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

AWAKE FOR LIFE, LLC

Practice address

143 N McCormick St Ste 103
Prescott, AZ 86301-2725

Phone

(928) 707-1841

NPI assigned

May 24, 2023

Organization subpart

No

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

Authorized official

Name

Nancy Gerlach, LCSWNPI 1710450879

Title

Owner

Phone

(928) 707-1841

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Practitioners 1

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

• Nancy Lynn Gerlach, LCSW

  • Professional Counselor
  • Prescott, AZ
  • NPI 1710450879

  Clinical

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1684886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684886400000",
    "number": "1891487062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 N MCCORMICK ST STE 103",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012725",
            "telephone_number": "928-707-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 N MCCORMICK ST STE 103",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863012725",
            "telephone_number": "928-707-1841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AWAKE FOR LIFE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-24",
        "last_updated": "2023-05-24",
        "certification_date": "2023-05-24",
        "status": "A",
        "authorized_official_last_name": "GERLACH",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "928-707-1841",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Clinical Social Worker in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.