=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922715051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BE EMPOWERED COUNSELING SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2022
-----------------------------------------------------
Last Update Date | 10/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 283 HAMILTON ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01604-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-433-7469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 283 HAMILTON ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01604-2228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-433-7469
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER/ OWNER
-----------------------------------------------------
Name | ALICIA S GREY
-----------------------------------------------------
Credential | LMHC
-----------------------------------------------------
Telephone | 617-433-7469
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------