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General NPI Number Information
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NPI Number | 1134737620
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Entity Type | Organization
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Legal Business Name | EMPOWERED GROWTH COUNSELING
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 2809 CONNERY WAY STE B
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City | MISSOULA
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State | MT
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Zip | 59808-1955
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Country | US
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Telephone | 208-502-0664
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Fax |
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Provider Business Mailing Address
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Address Line | 2809 CONNERY WAY STE B
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City | MISSOULA
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State | MT
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Zip | 59808-1955
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Country | US
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Telephone | 208-502-0664
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | CANDACE MIREA
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Credential | LCSW, LAC
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Telephone | 208-502-0664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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