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General NPI Number Information
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NPI Number | 1346134483
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Entity Type | Organization
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Legal Business Name | EMPIRE WELLNESS MENTAL HEALTH GROUP
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Dates
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Enumeration Date | 06/04/2025
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Last Update Date | 06/04/2025
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Provider Practice Location Address
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Address Line | 12522 ELVINS ST
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City | LAKEWOOD
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State | CA
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Zip | 90715-1831
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Country | US
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Telephone | 657-754-6111
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Fax |
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Provider Business Mailing Address
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Address Line | 12522 ELVINS ST
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City | LAKEWOOD
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State | CA
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Zip | 90715-1831
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Country | US
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Telephone | 657-754-6111
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Fax |
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Authorized Official
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Title or Position | OWNER / CHIEF CLINICAL OFFICER
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Name | SAMANTHA BROWN
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Credential | LPCC
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Telephone | 216-307-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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