Healthcare Provider Details

I. General information

NPI: 1881053023
Provider Name (Legal Business Name): EMPOWER THERAPY GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GRACELAND DR SE SUITE C
ALBUQUERQUE NM
87108-2778
US

IV. Provider business mailing address

PO BOX 70113
ALBUQUERQUE NM
87197-0113
US

V. Phone/Fax

Practice location:
  • Phone: 505-750-2648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC07191
License Number StateNM

VIII. Authorized Official

Name: KAREE POWERS
Title or Position: OWNER
Credential: LCSW
Phone: 505-750-2648