MEDICARE: EMPOWERMENT THERAPY CENTER, LLC

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	4606	CO
2	251S00000X	Community/Behavioral Health Agency	2896	CO
3	251S00000X	Community/Behavioral Health Agency	4486	CO
4	251S00000X	Community/Behavioral Health Agency	2060	CO
5	251S00000X	Community/Behavioral Health Agency	11132	CO
6	251S00000X	Community/Behavioral Health Agency	6395	CO
7	101YA0400X	Addiction (Substance Use Disorder) Counselor	7403	CO
8	101YA0400X	Addiction (Substance Use Disorder) Counselor	427	CO
9	101YP2500X	Professional Counselor	11132	CO
10	101YP2500X	Professional Counselor	2060	CO
11	101YP2500X	Professional Counselor	4486	CO
12	101YP2500X	Professional Counselor	6395	CO
13	103T00000X	Psychologist	2896	CO
14	101YP2500X	Professional Counselor	4606	CO

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952542037
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMPOWERMENT THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	5855 LEHMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3423
Country	:	US
Telephone Number	:	719-329-1900
Fax Number	:	719-329-1901

Provider Business Practice Location Address
First Line	:	5855 LEHMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3423
Country	:	US
Telephone Number	:	719-329-1900
Fax Number	:	719-329-1901

Authorized Official
Title or Position	:	OWNER
Name	:	SUSAN BELL
Credential	:	MA, LPC
Telephone Number	:	719-329-1900

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	08/05/2016

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