MEDICARE: EMPOWERME MENTAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	11102	LA

General Provider Information

NPI Number	:	1336626118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERME MENTAL HEALTH

Provider Business Mailing Address
First Line	:	14056 PARK TERRACE DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70810-0461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5522 JONES CREEK RD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-2158
Country	:	US
Telephone Number	:	225-772-0402
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MRS. JAIME HILTON
Credential	:	LCSW
Telephone Number	:	225-772-0402

Provider Enumeration Date	:	07/24/2018
Last Update Date	:	07/24/2018

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