Healthcare Provider Details

I. General information

NPI: 1457829178
Provider Name (Legal Business Name): EMPOWERMENT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2018
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 S MADISON ST
LANCASTER WI
53813-2186
US

IV. Provider business mailing address

702 S MADISON ST
LANCASTER WI
53813-2186
US

V. Phone/Fax

Practice location:
  • Phone: 815-291-6844
  • Fax:
Mailing address:
  • Phone: 608-723-4433
  • Fax: 608-535-6862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA LEIBFRIED
Title or Position: LICENSING PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 608-723-4433