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General NPI Number Information
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NPI Number | 1437455573
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Entity Type | Organization
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Legal Business Name | EMPOWERING SYSTEMIC THERAPY, LLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 11172 HURON ST SUITE 25-A
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City | NORTHGLENN
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State | CO
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Zip | 80234
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Country | US
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Telephone | 720-975-7824
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Fax |
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Provider Business Mailing Address
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Address Line | 702 WEST WILLOW ST.
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City | LOUISVILLE
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State | CO
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Zip | 80027
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | RYAN FORREST
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Credential | LPC, LMFT
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Telephone | 720-975-7824
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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 | CSW-1686
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT-865
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-4857
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License Number State | CO
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