Healthcare Provider Details

I. General information

NPI: 1871615468
Provider Name (Legal Business Name): SELF EMPOWERMENT CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 SOUTH NAPERVILLE ROAD SUITE #207
WHEATON IL
60189
US

IV. Provider business mailing address

1751 SOUTH NAPERVILLE ROAD SUITE #207
WHEATON IL
60189
US

V. Phone/Fax

Practice location:
  • Phone: 630-774-8316
  • Fax: 630-690-3353
Mailing address:
  • Phone: 630-774-8316
  • Fax: 630-690-3353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: ASIF ALI KHAN
Title or Position: PRESIDENT
Credential: PSYD
Phone: 630-774-8316