Provider Demographics
NPI:1801503271
Name:EMPOWERED BEHAVIORAL AND CLINICAL SERVICES LLC
Entity type:Organization
Organization Name:EMPOWERED BEHAVIORAL AND CLINICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUKIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:734-337-0959
Mailing Address - Street 1:1710 DOUGLAS DR N STE 225S
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4365
Mailing Address - Country:US
Mailing Address - Phone:734-337-0959
Mailing Address - Fax:
Practice Address - Street 1:1710 DOUGLAS DR N STE 225S
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4365
Practice Address - Country:US
Practice Address - Phone:734-337-0959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health