Healthcare Provider Details

I. General information

NPI: 1245976331
Provider Name (Legal Business Name): EMPOWERING YOUNG PEOPLE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13806 STATE ROAD 33
GROVELAND FL
34736-9499
US

IV. Provider business mailing address

9200 OAK ISLAND LN
CLERMONT FL
34711-7304
US

V. Phone/Fax

Practice location:
  • Phone: 352-874-0639
  • Fax:
Mailing address:
  • Phone: 352-874-0639
  • 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
# 3
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY BERNARD MCCOY JR.
Title or Position: CEO
Credential:
Phone: 352-874-0639