Healthcare Provider Details

I. General information

NPI: 1447996343
Provider Name (Legal Business Name): EMPOWER PSYCHOTHERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16601 N 40TH ST STE 216
PHOENIX AZ
85032-3354
US

IV. Provider business mailing address

4153 E STONY MEADOW DR
TUCSON AZ
85756-3077
US

V. Phone/Fax

Practice location:
  • Phone: 480-291-0769
  • Fax:
Mailing address:
  • Phone: 301-798-4588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRYAN TERENCE GASTELLE
Title or Position: FOUNDER/CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 301-471-6944