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General NPI Number Information
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NPI Number | 1841679545
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Entity Type | Organization
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Legal Business Name | EMPOWERED LIFE COUNSELING, PLLC
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Dates
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Enumeration Date | 05/27/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 5800 E SKELLY DR SUITE 105
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City | TULSA
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State | OK
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Zip | 74135-6471
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Country | US
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Telephone | 918-991-5538
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Fax | 918-271-5065
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Provider Business Mailing Address
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Address Line | 5800 E SKELLY DR SUITE 105
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City | TULSA
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State | OK
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Zip | 74135-6471
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Country | US
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Telephone | 918-991-5538
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Fax | 918-271-5065
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MRS. ALISA JOHNSON
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Credential | LPC
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Telephone | 918-991-5538
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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 | 5181
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License Number State | OK
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