Healthcare Provider Details

I. General information

NPI: 1992189070
Provider Name (Legal Business Name): EMPOWERED LIFE COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 RIVERPLACE BLVD, 1571 SUITE 105
JACKSONVILLE FL
32207-9092
US

IV. Provider business mailing address

1200 RIVERPLACE BLVD, 1571 SUITE 105
JACKSONVILLE FL
32207-9092
US

V. Phone/Fax

Practice location:
  • Phone: 954-492-7553
  • Fax:
Mailing address:
  • Phone: 954-492-7553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH 10889
License Number StateFL

VIII. Authorized Official

Name: DR. REMY NELSON
Title or Position: PRESIDENT & CEO
Credential: PHD
Phone: 954-492-7553