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General NPI Number Information
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NPI Number | 1679732887
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Entity Type | Organization
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Legal Business Name | EMPOWER THERAPEUTIC SUPPORT SERVICES PLLC
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Dates
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Enumeration Date | 06/03/2008
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 227 COLFAX AVE N SUITE 15
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City | MINNEAPOLIS
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State | MN
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Zip | 55405
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Country | US
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Telephone | 612-223-0373
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Fax | 612-781-2428
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Provider Business Mailing Address
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Address Line | 227 COLFAX AVE N SUITE 15
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City | MINNEAPOLIS
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State | MN
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Zip | 55405
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Country | US
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Telephone | 612-223-0373
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Fax | 612-223-0373
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Authorized Official
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Title or Position | PRESIDENT
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Name | CEDRIC WEATHERSPOON
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Credential | LMFT
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Telephone | 612-233-0373
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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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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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