Healthcare Provider Details

I. General information

NPI: 1497353171
Provider Name (Legal Business Name): EMPOWERED LIFE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10820 SUNSET OFFICE DR STE 220
SAINT LOUIS MO
63127-1030
US

IV. Provider business mailing address

PO BOX 31022
SAINT LOUIS MO
63131-0022
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-0617
  • Fax: 314-328-5489
Mailing address:
  • Phone: 314-275-0617
  • Fax: 314-328-5489

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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KARA A DIAL
Title or Position: OWNER/PROVIDER
Credential:
Phone: 314-275-0617