Healthcare Provider Details

I. General information

NPI: 1447968516
Provider Name (Legal Business Name): EMPOWER CHICAGO THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 S. MICHIGAN AVE STE 121 #5151
CHICAGO IL
60604
US

IV. Provider business mailing address

332 S. MICHIGAN AVE STE 121 #5151
CHICAGO IL
60604
US

V. Phone/Fax

Practice location:
  • Phone: 858-243-6812
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER COLEMAN
Title or Position: MANAGER
Credential:
Phone: 858-243-6812