Healthcare Provider Details

I. General information

NPI: 1295356897
Provider Name (Legal Business Name): EMPOWER COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5497 W WATERFORD LN STE C
APPLETON WI
54913-8489
US

IV. Provider business mailing address

5497 W WATERFORD LN STE C
APPLETON WI
54913-8489
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-4255
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER MARKVART
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 920-543-3619