Healthcare Provider Details

I. General information

NPI: 1194491415
Provider Name (Legal Business Name): EMPOWERED PATH PSYCHOTHERAPY FOR ANXIETY AND OCD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2021
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N AUGUSTA DR
WADSWORTH IL
60083-9283
US

IV. Provider business mailing address

3075 N AUGUSTA DR
WADSWORTH IL
60083-9283
US

V. Phone/Fax

Practice location:
  • Phone: 847-804-6801
  • Fax:
Mailing address:
  • Phone: 847-804-6801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA ROUETTE
Title or Position: OWNER/FOUNDER/LEAD THERAPIST
Credential: LCSW
Phone: 847-804-6801