Healthcare Provider Details

I. General information

NPI: 1205706611
Provider Name (Legal Business Name): EMPOWER POTENTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W 7TH ST
VEEDERSBURG IN
47987-1108
US

IV. Provider business mailing address

113 W 7TH ST
VEEDERSBURG IN
47987-1108
US

V. Phone/Fax

Practice location:
  • Phone: 217-649-5181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ERIK CISNEY
Title or Position: OWNER
Credential:
Phone: 217-649-5181