Healthcare Provider Details

I. General information

NPI: 1023986460
Provider Name (Legal Business Name): EMPOWERMENTAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 SOUTHFIELD RD STE 255
SOUTHFIELD MI
48075-4238
US

IV. Provider business mailing address

27010 CARLYSLE ST
INKSTER MI
48141-2554
US

V. Phone/Fax

Practice location:
  • Phone: 248-469-8470
  • Fax:
Mailing address:
  • Phone: 313-817-7568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WELLS
Title or Position: OWNER
Credential:
Phone: 313-817-7568