Healthcare Provider Details

I. General information

NPI: 1821942632
Provider Name (Legal Business Name): EMPOWER YOUR MIND BEHAVIORAL HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 N 1ST ST FL 2
SAN JOSE CA
95131-1035
US

IV. Provider business mailing address

2570 N 1ST ST FL 2
SAN JOSE CA
95131-1035
US

V. Phone/Fax

Practice location:
  • Phone: 786-809-1112
  • Fax:
Mailing address:
  • Phone: 786-809-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA JORDAN
Title or Position: OWNER
Credential:
Phone: 786-809-1112