Healthcare Provider Details

I. General information

NPI: 1053296905
Provider Name (Legal Business Name): EMPOWER YOU FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2025
Last Update Date: 08/09/2025
Certification Date: 08/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E CARMEL DR STE 117
CARMEL IN
46032-3049
US

IV. Provider business mailing address

5140 E SOUTHPORT RD STE 1041
SOUTHPORT IN
46237-9601
US

V. Phone/Fax

Practice location:
  • Phone: 463-999-9203
  • Fax: 463-388-2323
Mailing address:
  • Phone: 463-800-3384
  • Fax: 463-388-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CANDICE JACKSON
Title or Position: PMHNP/PRESIDENT
Credential: NP
Phone: 317-493-6456