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General NPI Number Information
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NPI Number | 1255793048
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Entity Type | Organization
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Legal Business Name | EMPOWERMENT CLINICAL AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 12/14/2023
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Provider Practice Location Address
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Address Line | 9500 RAY WHITE RD STE 200
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City | FORT WORTH
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State | TX
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Zip | 76244-9105
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Country | US
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Telephone | 817-329-5074
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Fax |
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Provider Business Mailing Address
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Address Line | 9500 RAY WHITE RD
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City | FORT WORTH
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State | TX
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Zip | 76244-6000
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Country | US
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Telephone | 804-922-1189
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Fax |
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Authorized Official
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Title or Position | CEO / OWNER
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Name | MR. TERRANCE EDWARDS
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Credential |
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Telephone | 804-922-1189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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