Healthcare Provider Details

I. General information

NPI: 1346007317
Provider Name (Legal Business Name): EMPOWERED COUNSELING CHICAGO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 N ASHLAND AVE APT 3E
CHICAGO IL
60640-3475
US

IV. Provider business mailing address

4838 N ASHLAND AVE APT 3E
CHICAGO IL
60640-3475
US

V. Phone/Fax

Practice location:
  • Phone: 630-818-6290
  • Fax:
Mailing address:
  • Phone: 630-818-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNA SOLDATI
Title or Position: CEO
Credential: LCPC, R-DMT
Phone: 630-818-6290