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General NPI Number Information
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NPI Number | 1467818948
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Entity Type | Organization
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Legal Business Name | EMPOWERED: A CENTER FOR SEXUALITY, LLC
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Dates
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Enumeration Date | 01/13/2016
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Last Update Date | 03/07/2016
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Provider Practice Location Address
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Address Line | 8000 BONHOMME AVE SUITE 201
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City | CLAYTON
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State | MO
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Zip | 63105-3515
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Country | US
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Telephone | 314-755-1593
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Fax | 314-755-1592
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Provider Business Mailing Address
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Address Line | 8000 BONHOMME AVE SUITE 201
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City | CLAYTON
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State | MO
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Zip | 63105-3515
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Country | US
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Telephone | 314-755-1593
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Fax | 314-755-1592
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Authorized Official
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Title or Position | CEO AND BEHAVIOR ANALYST
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Name | NICHOLAS MAIO
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Credential | MSP, BCBA, LBA
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Telephone | 314-808-8168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | LC001464774
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License Number State | MO
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