Healthcare Provider Details

I. General information

NPI: 1437455573
Provider Name (Legal Business Name): EMPOWERING SYSTEMIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2011
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11172 HURON ST SUITE 25-A
NORTHGLENN CO
80234
US

IV. Provider business mailing address

702 WEST WILLOW ST.
LOUISVILLE CO
80027
US

V. Phone/Fax

Practice location:
  • Phone: 720-975-7824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-4857
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW-1686
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-865
License Number StateCO

VIII. Authorized Official

Name: RYAN FORREST
Title or Position: PARTNER
Credential: LPC, LMFT
Phone: 720-975-7824