MEDICARE: EMPOWER WELLNESS THERAPY SERVICES

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	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538961453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWER WELLNESS THERAPY SERVICES

Provider Business Mailing Address
First Line	:	1314 BROOKFOREST DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-5041
Country	:	US
Telephone Number	:	614-202-1522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 BROOKFOREST DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-5041
Country	:	US
Telephone Number	:	614-202-1522
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER
Name	:	JORDAN ALLEN
Credential	:	LISW
Telephone Number	:	614-202-1522

Provider Enumeration Date	:	03/24/2025
Last Update Date	:	03/24/2025

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