Provider Demographics
NPI:1194531350
Name:SPACIOUS AWARENESS LLC
Entity type:Organization
Organization Name:SPACIOUS AWARENESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:BAILO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:440-382-7179
Mailing Address - Street 1:9960 LYNN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8886
Mailing Address - Country:US
Mailing Address - Phone:440-382-7179
Mailing Address - Fax:
Practice Address - Street 1:9960 LYNN LAKE RD
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8886
Practice Address - Country:US
Practice Address - Phone:440-382-7179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-03
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health