Healthcare Provider Details

I. General information

NPI: 1447490073
Provider Name (Legal Business Name): EMPOWERMENT CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5257 NE MARTIN LUTHER KING JR BLVD STE 201&202
PORTLAND OR
97211-3282
US

IV. Provider business mailing address

150 NE 3RD AVE STE A
HILLSBORO OR
97124-3150
US

V. Phone/Fax

Practice location:
  • Phone: 503-676-3710
  • Fax: 503-430-5403
Mailing address:
  • Phone: 503-851-0059
  • Fax: 503-430-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number2800
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2800
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number2800
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number2800
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number2800
License Number StateOR
# 10
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number20105014NP
License Number StateOR
# 11
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number20105014NP
License Number StateOR
# 12
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateOR

VIII. Authorized Official

Name: MICHAEL BRAXTON
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW, CADC III, QMHP
Phone: 503-676-3710