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General NPI Number Information
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NPI Number | 1528529856
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Entity Type | Organization
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Legal Business Name | EMPOWERMENT BEHAVIORAL CARE LLC
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Dates
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Enumeration Date | 03/28/2019
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 6448 W COLTER ST
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City | GLENDALE
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State | AZ
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Zip | 85301-6527
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Country | US
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Telephone | 623-206-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 6448 W COLTER ST
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City | GLENDALE
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State | AZ
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Zip | 85301-6527
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Country | US
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Telephone | 623-206-0557
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Fax |
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Authorized Official
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Title or Position | OWNER/PROGRAM DIRECTOR
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Name | KENNETH J MIMS
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Credential |
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Telephone | 602-507-0320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 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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Taxonomy #3
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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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