Healthcare Provider Details

I. General information

NPI: 1659013209
Provider Name (Legal Business Name): EMPOWERED PATHWAYS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E PACIFIC COAST HWY # 1075
LONG BEACH CA
90806-5102
US

IV. Provider business mailing address

1124 E PACIFIC COAST HWY # 1075
LONG BEACH CA
90806-5102
US

V. Phone/Fax

Practice location:
  • Phone: 850-688-6761
  • Fax: 678-840-3887
Mailing address:
  • Phone: 850-688-6761
  • Fax: 678-840-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVANGELINE BESS
Title or Position: OWNER
Credential:
Phone: 850-688-6761