Healthcare Provider Details

I. General information

NPI: 1235522285
Provider Name (Legal Business Name): EMPOWER BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6222 W IH 10 STE 104
SAN ANTONIO TX
78201-2013
US

IV. Provider business mailing address

6222 W IH 10 STE 104
SAN ANTONIO TX
78201-2013
US

V. Phone/Fax

Practice location:
  • Phone: 210-447-0039
  • Fax: 210-579-7100
Mailing address:
  • Phone: 210-447-0039
  • Fax: 210-579-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: NATESH KUMAR
Title or Position: CEO
Credential:
Phone: 469-855-6311