Healthcare Provider Details

I. General information

NPI: 1104360734
Provider Name (Legal Business Name): FAMILY EMPOWERMENT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 HARMONY PATH
SAINT JOSEPH MI
49085-8298
US

IV. Provider business mailing address

2630 HARMONY PATH
SAINT JOSEPH MI
49085-8298
US

V. Phone/Fax

Practice location:
  • Phone: 269-759-8750
  • Fax:
Mailing address:
  • Phone: 269-759-8750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JOHN W WELLS III
Title or Position: OWNER/MANAGER
Credential: PSYD, MA, LLP
Phone: 269-759-8750