Healthcare Provider Details

I. General information

NPI: 1275314205
Provider Name (Legal Business Name): EMPOWERED GROWTH PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 STRANG LN
RANCHO CUCAMONGA CA
91701-1440
US

IV. Provider business mailing address

4343 MACARTHUR BLVD # 1139
NEWPORT BEACH CA
92660-2021
US

V. Phone/Fax

Practice location:
  • Phone: 909-938-2967
  • Fax:
Mailing address:
  • Phone: 909-294-2816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DEANNA AGHBASHIAN
Title or Position: SOLE PROPRIETOR
Credential: LCSW
Phone: 909-938-2967