Healthcare Provider Details

I. General information

NPI: 1144961319
Provider Name (Legal Business Name): EMPOWERED PATHWAYS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3157 GENTILLY BLVD
NEW ORLEANS LA
70122-3872
US

IV. Provider business mailing address

3994 VILLA LAKE RD
POWDER SPRINGS GA
30127-5051
US

V. Phone/Fax

Practice location:
  • Phone: 850-688-6761
  • Fax:
Mailing address:
  • Phone: 850-688-6761
  • Fax: 678-840-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. EVANGELINE BESS
Title or Position: OWNER
Credential:
Phone: 850-688-6761