Provider Demographics
NPI:1861955296
Name:EMPOWER COUNSELING LLC
Entity type:Organization
Organization Name:EMPOWER COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NICHOLE
Authorized Official - Last Name:BERNARDY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-532-1477
Mailing Address - Street 1:4675 40TH AVE S STE 130
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-4444
Mailing Address - Country:US
Mailing Address - Phone:701-532-1477
Mailing Address - Fax:701-532-1801
Practice Address - Street 1:1790 32ND AVE S STE 1
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5942
Practice Address - Country:US
Practice Address - Phone:701-532-1477
Practice Address - Fax:701-532-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-11
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty