Healthcare Provider Details

I. General information

NPI: 1548191356
Provider Name (Legal Business Name): EMPOWERED LIVING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 QUEBEC ST STE 4300
DENVER CO
80207-2322
US

IV. Provider business mailing address

3401 QUEBEC ST STE 4300
DENVER CO
80207-2322
US

V. Phone/Fax

Practice location:
  • Phone: 720-315-4647
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: ANAHITA LAKE-KHOSRAVI
Title or Position: PROVIDER
Credential:
Phone: 720-315-4647