Healthcare Provider Details

I. General information

NPI: 1003700014
Provider Name (Legal Business Name): EMPOWER MINDS ABA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 YGNACIO VALLEY RD STE 210B
WALNUT CREEK CA
94598-2860
US

IV. Provider business mailing address

1399 YGNACIO VALLEY RD STE 210B
WALNUT CREEK CA
94598-2860
US

V. Phone/Fax

Practice location:
  • Phone: 925-307-9145
  • Fax:
Mailing address:
  • Phone: 925-307-9145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FANNY LEZAMETA
Title or Position: CEO
Credential:
Phone: 925-307-9145