Healthcare Provider Details

I. General information

NPI: 1801723416
Provider Name (Legal Business Name): EMPOWERED PATH COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

IV. Provider business mailing address

732 S 6TH ST STE N
LAS VEGAS NV
89101-6928
US

V. Phone/Fax

Practice location:
  • Phone: 725-314-2901
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ASHANTA FULMORE
Title or Position: MANAGING MEMBER
Credential: LCPC
Phone: 725-314-2901