Provider Demographics
NPI:1528529625
Name:EMPOWERED MATURITY PLLC
Entity type:Organization
Organization Name:EMPOWERED MATURITY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HENTSCH-COWLES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, NCC, CSAT, LPC
Authorized Official - Phone:469-480-9098
Mailing Address - Street 1:5225 VERDE VALLEY LN APT 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7901
Mailing Address - Country:US
Mailing Address - Phone:203-451-6385
Mailing Address - Fax:
Practice Address - Street 1:13355 NOEL RD STE 1100
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6694
Practice Address - Country:US
Practice Address - Phone:469-480-9098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health